Achilles rupture: Evolving treatment with Sanford Health

Brendan Cook's recovery from a ruptured Achilles was shortened considerably by an alternative procedure.

Brendan Cook with a cast on his leg after an Achilles rupture.

Brendan Cook’s ruptured Achilles had ironic elements that he can now laugh about. What this injury did not have was a long and painful rehabilitation or a less-than-complete recovery.

In fact, in hindsight Cook was comfortable with what can be a very uncomfortable process thanks to the work of Dr. Andrew Johnson, a podiatrist at Sanford Health Detroit Lakes whose repair of the Achilles in September using an increasingly popular alternative procedure set Cook on his way to a smooth return to full speed.

“Achilles tendon ruptures, no matter what technique is performed, are still long recoveries,” Johnson said. “But this technique we used with Brendan decreases the amount of non-weight bearing time because of its level of strength. That, in and of itself, is very beneficial to patients.”

It was definitely beneficial to Cook, a 35-year-old married father of two who played in 136 NCAA Division I hockey games for Bemidji State University and another 639 more professional regular-season games in the United States and Europe prior to retiring in 2017.

Not the ninja he thought he was

He did not completely sever his Achilles playing hockey. That’s where the irony comes in. No, he did it while climbing a wall patterned after the one featured in “American Ninja Warrior,” a television show his children like to watch.

This was one of the promised activities to the Cook children on a family weekend in the Twin Cities. Their scheduled hour at an Eden Prairie training gym affiliated with the popular program was coming to a close. But they all had time for one more trip up the “Warped Wall.”

“I planted hard with my first step with my right foot to drive myself up,” said Cook, who had already made it to the top of the 13-foot wall several times that day. “You could hear it pop. I went down to all fours and there were a few people who were in there whose jaws were on the floor.”

Cook’s wife Melissa asked what happened. Brendan, who’d endured countless injuries during his time in hockey but never this one, didn’t have to guess at an answer. He’d ruptured his Achilles.

“She said ‘Are you sure?’” Brendan said. “I said ‘Yeah, I’m sure.’ My foot was just kind of hanging there.  I could put my finger where my Achilles should be and it wasn’t there anymore.”

Speeding up recovery

The injury took place on a Saturday. On Monday morning the Perham, Minn., resident traveled 25 miles to Detroit Lakes to meet with Johnson. The doctor confirmed what both of them already knew. This was a complete tear of the Achilles and would require surgery.

That took place on Wednesday and Cook went home the same day.

“One of the cool things about this procedure is that it used to be that you were laid up for quite a while,” Cook said. “They’d stick you in a cast and you’d be immobile for about two months before you could do anything. The problem there is that your calf atrophies so much that when you do get out of the cast, the recovery takes forever.”

Achilles weekend warriors

Achilles issues are not as common as injuries involving knees and ankles. Incidences are on the rise, though, as “weekend warriors” trend toward bolder physical challenges. Men in their 40s and 50s are the most popular targets.

Ian Lackey is an athletic trainer for Sanford Orthopedics & Sports Medicine who spends most of his time working with the NBA G-League’s Sioux Falls Skyforce. He’s also a former Achilles rupture victim himself.

In his professional opinion, the injury happened to him — he was 22 at the time — because he was out of shape. He has since learned this is a common cause.

“You’re seeing the weekend warriors in their 40s deciding to play more basketball,” Lackey said. “Their tendons are exposed to the jumping and stopping and it can cause an overload of the tendon. I compare it to throwing a baseball all offseason and then when the season opens you try to throw the shot put.”

The Achilles is a tendon, not a muscle, but behaves similarly in some respects. More activity makes it stronger. Less activity makes it thinner and less powerful. Hence, mixing an under-used Achilles with a sudden overload can lead to visits to the podiatrist.

“It’s a pretty simple injury,” Lackey said. “It’s not like a shoulder or a knee where there are so many different forces. An Achilles has one motion — basically up and down — and you can get a complete range of motion and strength and power back. But it can take a long time.”

Achilles rupture surgery options

There are several ways Achilles ruptures are repaired. Conventionally, when surgery seems the best option, a long vertical incision is made along the lower calf area and the two severed ends of the tendon are sewn together with sutures.

The procedure Johnson used on Cook’s Achilles called for a much smaller incision. Several sutures are applied horizontally through the upper part of the ruptured Achilles and are threaded vertically through the lower portion of the Achilles, then attached to the heel. The sutures are anchored in the back of the heel bone and the severed ends of the rupture are pulled together.

And the result: Cook had a less invasive surgery and was back on his feet in a shorter time.

Stronger, and in less time

“In my opinion it’s a much stronger repair than the traditional way,” said Johnson, who grew up in Detroit Lakes. “And it’s knot-less. There are no exposed knots under the skin. It’s all buried within the tendon. The reason why I really like this technique is that there is minimal surgical exposure or incisions. The strength is either the same or greater than the older methods we’ve utilized for Achilles ruptures.”

It affords patients and doctors more confidence in the strength of the repair. In this case that allowed Cook a shorter wait time to begin working on his range of motion and weight-bearing rehab.

He was in bed for a few days, then moved on to a knee scooter that his children loved. He wore a walking boot after three weeks and lived a relatively normal life. At seven weeks he was out of the boot.

“Being able to walk with a heeled shoe short of two months is a pretty big win,” Cook said. “The healing time was as short as it possibly could have been. I was very appreciative and grateful for that.”

Achilles repair close to home

Cook’s athletic background, coupled with his active lifestyle, meant he could take an aggressive approach to rehabbing his Achilles rupture.

“I wanted to get back as quick as possible to doing the things I like to do — I needed to regain my sanity,” Cook said. “I didn’t want to just walk around with my family, be able to work and wear normal shoes. I still had the mindset that I was an athlete even though I no longer am an athlete. That’s the way I looked at it.”

Encouragingly for Cook and others in the region, the best choice for surgery and recovery was located within a half-hour drive of his home.

“You don’t look into this kind of surgery until you’re the one who needs the surgery,” Cook said. “It’s super-valuable to have the opportunity to have the procedure done near home and get the same repair that any NFL player would have. When you liken it to that kind of scenario, that’s a pretty cool thing. You get the same quality repair that any professional athlete would get.”

His surgeon agrees with that.

“Population density doesn’t necessarily mean better care,” Johnson said. “I’ve never believed that. I grew up in Detroit Lakes and I was very happy to come back to my hometown to utilize my training. I really think that our ambulatory surgery center and the staff there is phenomenal.”

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Posted In Orthopedics, Rehabilitation & Therapy, Sports Medicine

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