Limited-Incision Knotless Achilles Tendon Repair

Acute midsubstance Achilles tendon ruptures, which are increasingly common among athletes, can result in significant functional limitations and decreased quality of life when not managed appropriately. The various surgical techniques for treating Achilles ruptures include open repair with Krackow locking sutures, percutaneous repair, and limited-incision repair with suture-passing jigs. Less invasive techniques have been developed to optimize the functional benefits of surgery while reducing delayed wound healing, infection, and other postoperative complications. An important albeit subjective aspect of Achilles tendon repair is suture knot tying and tensioning around the rupture site. Recently, a limited-incision knotless Achilles tendon repair technique (Achilles Midsubstance SpeedBridge; Arthrex) was developed to minimize soft-tissue dissection, restore musculotendinous length, and directly fix tendon to bone to allow for early mobilization and more rapid functional recovery. The indications, contraindications, details, pearls, and pitfalls of this surgical technique are discussed in this article.