Ahnadlass’s AchillesBlog

I had an ultrasound (US), and the US doctor told me there that the tendon was thin and that there was a cavity in the tendon at the rupture zone. Then I went back to the surgeon that had done the first surgery. He had a quick look at the tendon and the US results. His opinion was that the tendon would slowly get better with physical therapy and time, and he encouraged me to continue my re-hab. Also, since it was already 3-months after the first surgery, he felt that the chances of re-rupture was fairly small.

I then went to the surgeon that was recommended by my sports doctor and PT. She is also not satisfied with the Tenolig results and has done several re-ops on patients whose tenoligs had failed. She had a look at my tendon and the US results and pronounced that a re-op was likely but an MRI would be necessary in order to determine the extent of the problem.

I did the MRI at about the 3.5 month mark, and it showed the same state - a hole/cavity in the tendon - although the tendon had thickened up a bit at the rupture site.  Here’s the shot from the MRI - notice the white spot in the middle of the black tendon:

I went back to the 2nd surgeon, and she confirmed that she was ready to cut. She gave me the likely sequence of the re-op:

1. Make an incision to open up the tendon and lower gastrocnemius.
2. Cut out the portion of the tendon at the rupture zone that has not properly re-attached, which includes the cavity.
3. Depending on the amount of tendon removed, lengthen the tendon by doing a V-Y plasty or turn-down flap. This involves cutting the gastroc or tendon and reattaching in a way to lower the upper part of the tendon.
4. Reattaching the tendon with sutures.
5. Closing the incision.
6. Start the standard open surgery re-hab PT etc.

We agreed on a re-op date of 14 September 2011, and I am not looking forward to it.

The Tenolig is an outpatient surgery, and I went home with a cast on my lower leg with strict immobilization instructions. There was wasn’t any pain until the evening when it started feeling like the cast was too tight. I was in agony that night, and called the doctor that day to get a stronger pain medication as apparently the cast was not too tight. Luckily after a few days the pain was much reduced. Tragically my mother died suddenly two weeks after my surgery, and I decided to make the train trip from France to the UK. This was a very painful experience as being seated or upright was uncomfortable after more than 15-30 minutes.

The cast came off after 3 weeks, and I started with an orthopedic boot in a toe-pointing position. I was allowed to put a bit of weight on the toe, and start sessions with the PT. My first sessions with the PT did not go well because the wires in the ankle were so painful I could barely move my ankle or move my toes. I also started back at work, and sitting at my desk for about 8 hours a day was also very painful. At 7 weeks, I went back to the clinic to have the wires pulled out, and the surgeon told me that everything was looking fine even if I hadn’t been able to do many exercises at PT.

I started doing more exercises with the PT at this stage - mostly balancing and stretching - after 7 weeks. I was wearing a shoe with a 3-part heel lift inside and using 2 crutches for stability, speed and safety especially on public transport. My PT had already expressed to me reservations about the Tenolig, but at this time he started noting that the tendon felt very thin at the rupture point. At 3 months after the surgery, this thin portion was still present, and my sports doctor who is in the same office as my PT suggested an ultrasound, and a second opinion. I also made an appointment with my first surgeon.

The hospital confirmed there was a full ATR and I scheduled an appointment with a surgeon for the next day at a private clinic in Paris where I went for my ACL surgery. I met with the surgeon and he gave me the following 3 options (along with his opinion of each):
1. Non-Surgical approach-using a series of casts which he did not recommend due to the risk of re-rupture. I had not had a chance to read this site so I was not aware of the divergence of opinion on this approach.
2. Traditional open surgery- opening up the rupture zone and suturing the 2 parts of the tendon together. He did not recommend this either as he believed the risk of infection and recovery time was longer than the 3rd method.
3. Percutaneous tenosynthesis ("Tenolig")- a French surgery inserting 2 wires into the 2 parts of the ruptured tendon to decrease the gap and allow it to grow back together. According to the surgeon the advantages were lowered risk of infection (there are just 4 small holes made where the wires are anchored) and a shorter recovery time as some mobilization is allowed after 3 weeks. The disadvantages are there is a second procedure to remove the wires and there is increased risk of re-rupture.
I chose the Tenolig and a surgery date 4 days after.

I was an active person in 2008-09 - cycling, ski racing, running, gym sessions, etc - but then I turned 40 and things started going wrong.  Firstly in December 2009, I blew out my left ACL ski racing in the first giant slalom race of the season.  In March 2010 I had the ACL recon surgery, my first, using the patellar tendon graft in March 2010, and chugged away at the slow and long rehab process.  By December 2010, I was skiing again and in January 2011 I was back to ski racing.  However my knee wasn’t feeling as good as new so I asked my physical therapist what I should do about that.  He said why not try soccer, tennis or another pivot sport. It turned out some of my young colleagues at work were playing 5-a-side soccer at lunch, and I decided to play with them.  The level was reasonable.  On April 1st 2011, I went to play my 2nd game with them.  It was a hot day, the artificial turf was sticky and I was wearing shoes with a thick gripy sole.  Our team let in a few bad goals so I started pushing to score - I sprinted up the field but the ball was behind me and I stopped hard and pushed off with my good leg (right) in the other direction.  The dorsiflexion hyper-extended my right achilles and it snapped with the sound of plywood breaking.  Having met several poor ATR patients in rehab, I knew exactly what had happened.  The game was over and I went to the hospital.