Re-injury after Achilles Tendon Surgery

Likelihood of Re-Injury After Achilles Tendon Surgery

Call 281-633-8600 for an appointment at our Sugar Land clinic and 713-234-3152 for an appointment at our clinic near the Houston Galleria.  This article is based on an episode of the Dr. Jay Show broadcast on AM1560TheGame in Houston, TX.  The subject of this section of the Show is the chance of re-injury after achilles tendon surgery.

Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician.  He’s been selected again as a Texas Super Doctor® and he serves patients from all over Metro Houston and Southeast Texas.  Dr. Bennett specializes in treating issues and injuries of the shoulder, elbow and knee and some hand and wrist injuries like carpal tunnel syndrome and trigger finger.

Dr. Bennett’s special guest for the show was Dr. Benoy Benny. He is a physical medicine rehabilitation physician, and he is board certified for pain and spine as well as for minimally invasive procedures in spine. He’s also a professor at Baylor College of Medicine.

Here’s the transcript of the third section of the Show talking about rehabilitation and the chance of re-injury after Achilles tendon surgery:

We’ve got some callers here that are waiting on the line and we want to go ahead and get our first caller here.  This is Barry.  Barry, what can we do for you today?

CALLER:  I may be calling a little off topic but I figured you guys have probably dealt with everything.  I had two questions:  (1) I had Achilles tendon surgery about a year ago and it’s getting better but I was curious as to what the likelihood is of tearing one again; and (2) I have some bursitis in a shoulder and I took anti-inflammatories and it got better, then worse.  I had a cortisone shot, it felt better for a little bit but now it seems to be back.  And I was wondering if it’s possible that the cortisone shots missed, or what the next step might be.

DR. J. MICHAEL BENNETT:  Now you had open Achilles tendon surgery where they actually repaired the tendon to the bone?

CALLER:  Yes.

DR. J. MICHAEL BENNETT:  And now you’re about a year out.  Regarding any type of tendon or ligament reconstruction or repair, the standard is usually around four to six months, or right around six months, where that scar tissue is mature enough to where you can actually start doing some sports-specific training.  And this is more along the lines for me like with rotator cuff repairs and ACLs and we had Dr. Vann on the show last week and he’s a specialist in foot and ankle, but usually it’s about six months. 

Now you can have some residual kind of stiffness and swelling and things like that up to a year after surgery and that’s not uncommon.  It’s nothing to really worry about.  As a matter of fact there’s studies that show you have a less likely chance of re-rupture if you have it fixed than if you don’t have it fixed, let’s say you just let it scar in.  Because there is a treatment modality out there where the people get treated with their foot being placed in kind of a ballerina position and that kind of helps those tendon ends get a little bit closer together and they’re casted in that position for a number of weeks and it fills in with scar tissue.  But the problem with that is that tendon is lengthened out because they don’t get those ends together and you get a lot of weakness and your risk of re-rupture is higher.  So it kind of depends on the type of tear.  If it’s a full tear and you’re young and athletic and you want that strength back, usually it’s my understanding that most people want to get that fixed.  Are you just having that soreness and stiffness?

CALLER:  No … and I’m old and athletic.  They did exactly what you said, they fixed it, they connected it, it’s just not as strong and it’s been about a year.  I know it takes time.  I was just curious about the chance of re-doing it and you’ve kind of told me that it probably should be fine.

DR. J. MICHAEL BENNETT:  I’ve seen numbers out there from 10 to 20 percent, I’ve even seen 15 percent in regards to chances of a re-injury, but it’s definitely lower than say, if you left it alone.  Now it also depends on the quality of your tissue; what it looked like when they went in there and repaired it.  Sometimes these tendons have a lot of calcium deposits in them, sometimes these tendons if its shortened and they had to debride an amount of the tendon, the repair is not as strong as say if they didn’t have to debride as much tendon, so a lot of it depends on what the surgeon did at that time and what your tendon looked like at that time. 

Now a big part of this is the rehabilitation post-operatively.  A lot of the weakness can be addressed with physical therapy and appropriate training, especially with sports-specific training after the surgery.  I usually start that around six months after real good, solid scar tissue has formed.   Feel free to bring this up with your surgeon or go to our website and check us out.  I’ve got plenty of sports med and foot and ankle docs that I work with that I can bring this up to as well.  

If you have questions about a sports injury or you’d like a second opinion regarding treatment, please call our office at 281-633-8600 for our Sugar Land office and 713-234-3152 for our Houston office.

Author
Dr. J. Michael Bennett

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