Ultrasonography-Guided Minimally Invasive Surgery for Achilles Sleeve Avulsions

Chi Yuan Liu, Tsung Chiao Wu, Kai Chiang Yang, Yi Chen Li, Chen Chie Wang

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Achilles sleeve avulsion, a relatively rare disorder, is characterized by sleeve-shaped injury extending from the calcaneus, located near the tendon insertion site. Unlike midsubstance tears of the Achilles tendon, end-to-end repair is difficult because less soft tissue is preserved distally. Open repair with transosseous sutures or suture anchors is currently favored. The purpose of this study was to evaluate the technical feasibility and functional outcomes of ultrasonography-guided Achilles sleeve avulsion repair. Methods: From November 2009 to April 2018, 21 patients with Achilles sleeve avulsions (mean age, 57.8 years; range, 25-82 years) who underwent repair by the same surgeon were retrospectively reviewed. The repair was achieved through a stab wound under ultrasonographic guidance. Two parallel Bunnell-type sutures were crossed over the proximal stump and tied with sutures from suture anchors fixed in the calcaneal tuberosity. Results: The mean operative time was 44 minutes, and the mean wound size was 1.5 cm. The patients were allowed to walk freely on postoperative week 6 with using high-ankle shoes. At postoperative 2 years’ follow-up, the American Orthopaedic Foot & Ankle Society score significantly improved from 70.9 to 97.1 (P <.05); similarly, their 12-item Short Form Health Survey scores improved significantly (P <.05). Only 2 patients had superficial wound infections, which resolved with wound care and oral antibiotics. Conclusion: Our ultrasonography-guided surgical technique for Achilles sleeve avulsions provided excellent soft tissue visualization and availability as well as minimized the wound length to achieve good postsurgical outcomes. Level of Evidence: Level IV, retrospective case series.

Original languageEnglish
Pages (from-to)544-553
Number of pages10
JournalFoot and Ankle International
Issue number5
Publication statusPublished - May 2021


  • Achilles sleeve avulsion
  • minimally invasive surgery
  • ultrasonography

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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