Robert B. Anderson, MD

The minimally invasive midsubstance surgical technique for acute midsubstance Achilles tendon ruptures passes sutures longitudinally through the distal Achilles stump and anchors proximal sutures into the calcaneus for early range of motion and weight-bearing.

Acute midsubstance Achilles tendon ruptures are an increasingly common injury among athletic patients that can lead to significant functional limitations and decreased quality of life. Management of these injuries remains controversial with no consensus in the literature regarding the role of surgical treatment or optimal repair technique. Recent literature has shown that surgical repair can result in faster and a 16% to 24% increased return of calf muscle strength, decreased tendon elongation and improved physical function and pain scores compared to nonoperative functional rehabilitation. Various surgical techniques have been described for midsubstance Achilles ruptures including open repair with Krackow locking sutures, limited incision repair using suture-passing jigs and percutaneous repair. The overall goal of minimally invasive Achilles repair techniques is to maximize the functional benefits of direct tendon repair while minimizing postoperative complications, such as delayed wound healing and infection.

Jones fractures are fractures of the proximal fifth metatarsal metaphyseal-diaphyseal junction that are common in young athletic populations, particularly elite athletes. The poor blood supply to the fifth metatarsal has been well documented, and Jones fractures develop along a watershed area between the intramedullary nutrient and metaphyseal arteries. Surgical fixation is indicated in cases of failed nonoperative treatment, re-fracture, nonunion or when more rapid recovery is required typically in active individuals.

A 15-year-old female high school athlete with no medical comorbidities presented to our clinic with progressively worsening left ankle pain for 8 months. She had been previously diagnosed at an outside institution with a medial talar osteochondral lesion found on radiographs and MRI without a history of trauma. She was initially treated with a course of immobilization in a tall CAM boot for 6 weeks followed by physical therapy for 6 weeks. The patient’s ankle pain persisted and she was re-immobilized in a non-weight bearing short leg cast for an additional 6 weeks. After failing nonoperative management, the patient underwent a left ankle arthroscopy with medial talar osteochondral lesion debridement and microfracture at the outside institution.