The Achilles tendon is the most commonly injured tendon, accounting for up to half of all tendon ruptures. The main group of patients are people who are involved in sports. In most cases, Achilles tendon injuries are treated with surgery. The tendon must be sutured and if this is not possible, then restored with the help of the patient's own tissues, donor materials, or synthetic implants. In Germany, these operations are reliable, minimally invasive and safe.

Content

1. Conservative Therapy
2. Principles of Surgical Treatment
3. Achilles Tendon Repair with Suturing
4. Achilles Tendon Plastic Surgery
5. Organization of Treatment Abroad

Conservative Therapy

In the 20th century, conservative treatment was considered one of the main options for managing patients, along with surgery. This is due to the fact that the operations of the 20th century were traumatic and often caused complications. Infact, every fourth patient suffered from complications. Today however, operations have become less traumatic and much safer. Therefore, the surgical method of treatment is considered the main one and conservative tactics are used only in cases where:

• the patient refuses the operation. 
• surgical intervention is contraindicated. 

Conservative treatment involves prolonged immobilization of the limb. This can last up to 3 months. The tendon eventually fuses together but it is not as strong as before. Intense physical activity becomes virtually impossible due to the high risk of repeated injury. Recurrence of injury after conservative therapy occurs in 1 in every 3 patients. In addition, during prolonged immobilization, limb muscles atrophy, which then requires patients to follow long-term rehabilitation to restore their muscles’ volume and strength.

Principles of Surgical Treatment

Surgery is considered the main treatment for an Achilles tendon rupture. The operation is performed as soon as possible. The best results are achieved in the first 10 days after the injury. Good results can also be obtained up to 3 weeks after the injury. After this period, the injury is considered old. The torn tendon develops degenerative changes and treatment becomes more difficult. Instead of suturing the tendon, doctors will then have to resort to a plastic repair.

In Germany, operations are safe and efficient, which is why athletes from all over the world travel to this country to benefit from the services of German surgeons. The risk of injury recurrence after surgery does not exceed 2% in Germany.

German hospitals give preference to minimally invasive surgical options. These surgical interventions are performed using percutaneous or endoscopic techniques.

The operation is followed by a full rehabilitation. Sparing methods of immobilization, early exercise, and physiotherapy are the measures that contribute to the speedy recovery of the function of the injured limb.

Achilles Tendon Repair with Suturing

If the tendon is torn, it can be sutured. However, suturing can only lead to the full restoration of the integrity of the Achilles tendon in the case of an acute injury, with the injury occurring no more than 2 weeks prior. If more time passes, the results worsen as degenerative changes in tissues will appear.

Operation options:

• open surgery. 
• percutaneous technique (without direct visual control).
• endoscopic surgery (under the guidance of a mini video camera). 

Open surgery is reliable and technically simple but traumatic.

Since the end of the 20th century, percutaneous techniques have been used in Germany. They involve suturing the Achilles tendon through an incision less than 1 cm long, with buried sutures. Previously, this procedure was carried out blindly and often caused complications. Today however, it is ultrasound-guided and only carried out with the use of special guides and staplers. Therefore, this procedure is successful on most patients and at the same time, minimally traumatic.

German hospitals perform endoscopic surgical procedures. These are performed through an incision up to 2 cm, with thin long instruments, under the guidance of a video camera. When using a minimally invasive method, the rehabilitation period is reduced.

Achilles Tendon Plastic Surgery

If the tendon cannot be sutured, it can be reconstructed from various materials: the patient's own tissues, donor tissues, as well as from artificial tendons. Plastic surgery may be required in the following cases:

• Achilles tendon rupture which occurred more than 2 weeks ago;
• fresh rupture with separation of fibers of the tendon ends. 

Autologous plastic surgery, in which doctors use the patient's own tissues, is considered the standard technique of performing this operation. Doctors take a fragment of another tendon, which leads to the increased trauma rate of the operation since additional trauma is applied to the donor site. This disadvantage however, is compensated by the advantages of auto-plasty:

• no risk of immune rejection. 
• fast engraftment of the autograft.
• good blood supply.
• maximum strength of the restored tendon, which is especially important for athletes and young, physically active people.
• the lowest risk of injury recurrence among all types of plastic surgery. 

For people who do not play sports, it is possible to use other plastic surgery options. A restored tendon is not as strong and can be ruptured under extreme loads. However, there is no additional trauma to the donor site and the risk of complications is lower. To perform plastic surgery, doctors use:

• allograft – preserved donor tendon. 
• xenograft – a fragment of bovine tendons.
• implants made of synthetic materials – artificial ligament prostheses. 

Organization of Treatment Abroad

The Booking Health company will help you to undergo Achilles tendon rupture diagnostics and Achilles tendon rupture treatment in Germany. On the Booking Health website you can find out the cost of different types of therapy, as well as compare prices for operations and procedures in the leading clinics in Germany. The staff of our company will select the best clinic specializing in the treatment of sports injuries and will fully organize your trip to Germany at the most favorable price. With the Booking Health Company, you will be able to undergo treatment easily, fully focusing on restoring your health.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

Articles for Orthopaedic Practice - Orthogate

Sience Direct