Technique Tip: Limited Dual Incision Technique for Repair of Achilles Sleeve Avulsions

The Achilles sleeve avulsion consists of tendon avulsed from the posterior calcaneus as a continuous sleeve, without avulsion of a bony element.1,2 The tissue remaining to the calcaneus is represented by a small tuft that does not provide enough tissue for a direct repair of the Achilles tendon to the donor site. Proximally displaced calcifications within the Achilles insertion may be a radiographic clue to the presence of the Achilles sleeve avulsion. An MRI confirms the presence of a sleeve avulsion (Fig. 1). Achilles sleeve avulsions are often associated with a large posterior-superior calcaneal prominence and premonitory insertional Achilles tendon pain. An operative technique has been previously described utilizing an extensile approach which facilitates repair by capturing the Achilles tendon with suture, resecting the posterior-superior calcaneal prominence, and securing the tendon to the posterior surface of the calcaneus via a transcalcaneal suture technique.1,2 This repair technique has been shown to provide a reliable, durable repair, with excellent clinical results, even in highdemand patients. In our earlier report, we utilized a standard incision approach for suture capture and mobilization of the Achilles tendon. In many patients, such as those with suboptimal skin conditions, marginal circulation, complicating medical comorbidities (e.g., diabetes, steroid use) in whom wound healing is potentially impaired, it is prudent to limit the length of the skin incision(s), provided that such an approach does not restrict the technical goals of the operation.