Orthopedics & Orthopedic Surgery
Area of Focus: Foot & Ankle
Dr. Laffenetre describes a standardized surgical percutaneous tenorrhaphy (Tenolig®) for patients with a traumatic rupture of the Achilles tendon.
Procedure: The patient is placed in the prone position withOUT a pneumatic tourniquet. Two harpoon sutures are percutaneously introduced from proximal to distal (one on each side of the tendon), crossing the site of the rupture and exiting the tendon just above its insertion. With the foot plantarflexed, each harpoon engages the proximal tendon and is pulled distally by the suture, which is tightened over a button by two lead crimps. The postoperative protocol is similarly standardised: no weightbearing with optional immobilisation in a boot for the first 3 weeks and prophylactic anticoagulation with LMWH. Rehabilitation starts immediately with the goal of achieving neutral position of the ankle at 3 weeks. At this point, rehabilitation intensifies. Weight-bearing is permitted with the patient wearing a therapeutic boot as a precaution, and a foot orthosis incorporating a heel lift is used, allowing muscle strengthening to begin. The orthoses are regularly reduced by 5 mm every 10 to 15 days. Sutures are removed under local anaesthesia on about day 45. At the end of day 90, the patient is assessed to determine if residual contracture indicates that the patient should continue wearing an orthosis during sporting activity.