Objective: Surgical treatment of Achilles tendon sleeve avulsion from its insertion is challenging. The purpose of this study is to report a surgical technique for Achilles tendon sleeve avulsion injuries including outcomes and complication in four patients.

Materials and Methods: A prospective case series of Achilles tendon sleeve avulsion injuries which underwent open gastrocnemius lengthening, calcaneal exostectomy, debridement of the Achilles tendon, and reattachment of the Achilles tendon to the calcaneus using double-row SutureBridgeTM technique was conducted. Patient self-reporting questionnaires and outcome measures including
general health (Short Form-36 [SF-36]), region-specific outcomes (Foot and Ankle Ability Measure [FAAM]), and pain measure (Visual Analogue Scale [VAS]) were recorded at pre- and final post-operative visits.

Results: Four male patients, mean age of 52 years, were included in this study. An average follow-up time was 15 months (range 12 to 18 months). There was significant improvement of SF-36 (25.4, 28.5, 24.1, and 28.7 which were improved to 50.5, 55.2, 51.7, and 52.8 for PCS and 42.4,
48.8, 45.2, and 46.2 which were improved to 55.9, 56.7, 54.3, and 59.8 for MCS); FAAM (60, 67, 65, and 68 which decreased to 21, 30, 30, and 33 for ADL and 0, 0, 0, and 0 which improved to 72, 70, 69, and 66 for sports); and VAS score (5, 7, 6, and 8 which decreased to 0, 0, 0, and 0) for the first, second, third, and fourth patients, respectively. All patients returned to daily activities and work at 6 weeks and returned to sports activities approximately 6 months post-operatively. There were no complications in this study.

Conclusion: The SutureBridgeTM technique appears to be an effective technique which has demonstrated promising results with minimal complications for treatment of Achilles tendon sleeve avulsion injury.

Keywords: Achilles Tendon Sleeve Avulsion, Achilles Tendon Rupture, Achilles Tendinopathy, SutureBridge technique