J Korean Foot Ankle Soc.  2021 Jun;25(2):89-94. 10.14193/jkfas.2021.25.2.89.

Management of Postoperative Complications Following Surgical Repair of Achilles Tendon Rupture

  • 1Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea


The surgical repair of an Achilles tendon acute rupture is a proven, traditional treatment for optimal functional recovery. However, concerns regarding complications such as re-rupture, wound problems and infections are driving new techniques, including minimally invasive approaches and nonoperative treatments. If we understand the characteristics and contemplate treatment strategies for possible complications, the surgical repair of the Achilles tendon is an attractive option and can be expected to yield satisfactory functional recovery.


Achilles tendon; Repair; Complications


  • Fig. 1 (A) A 58-year-old male patient who underwent surgical repair of Achilles tendon two months ago visited clinic due to persistent painful limping. T1-weighted sagittal magnetic resonance image showed high signal intensity and thinning of tendon suture site on Achilles lesion. (B) Turn-down flap from gastrocnemius was made after removing the remnant suture materials and the lesion. After removing the remnant suture materials and the lesion, we made turn-down flap from the gastrocnemius. (C) The gastrocnemius flap was pulled and sutured with the distal tendon in a plantarflexion position, and the remnant surrounding tissue was reconstructed on it.

  • Fig. 2 (A) The ultrasound image showed a gap (white bilateral arrows) caused by loss of continuity of Achilles tendon in the patients with re-rupture of Achilles tendon during hiking, who was a 71-year-old male and had a surgical history for a ruptured Achilles tendon 7 months ago. (B) The gap was narrowed after 2 months by conservative management including heel lifting and activity modification. (C) After three months of conservative treatment, the follow-up ultrasound image showed narrower gap and thicker surrounding tissue (small empty arrows), which replaced substantial continuity and the gait was improved.

  • Fig. 3 (A) A 39-year-old male patient visited clinic with an open wound and pus discharge that lasted six months after the open repair of Achilles tendon. (B) The enhanced T2-weighted sagittal magnetic resonance image showed infectious tissue accompanied by abscess but continuity of Achilles tendons was maintained. (C) The infectious tissue of tendon was extensively debrided and simple skin suture was performed after elliptic resection of sinus tract. Stiches were removed at 3 weeks after the surgery. The patient started normal gait at postoperative 10 weeks and returned to previous sports activity at postoperative 6 months.

  • Fig. 4 (A) Magnetic resonance image (MRI) of a 64-year-old male patient who visited clinic due to infected disruption of the surgical wound after the open repair of Achilles tendon rupture, shows continuity loss and infection. The T2-weighted sagittal MRI showed loss of continuity and infectious lesions in Achilles tendons for a 64-year-old male patient who visited our clinic due to claudication and infected surgical wound after the open repair of Achilles tendon rupture. (B) After complete resection of the infected Achilles tendon, he was treated with a 6-week short leg cast and then 6-week short leg brace, and the continuity of fibrous tissue was observed in ultrasound image 5 years after the surgery. His activity was recovered as same with the pre-injury level. Complete resection of infected Achilles tendon was performed and treated in the order of a 6-week short leg cast and then 6-week short leg brace. The ultrasound image at postoperative 5 year showed the continuity of fibrous tissue and the patients was recovered to previous injury activity level. (C) Ultrasound image for contralateral side.


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