# Evaluation of a modified Bunnell suture technique with sequential tensioning for tension-offloading in Achilles tendon rupture repair: a case series and description of the surgical technique

## TL;DR

A modified surgical technique for Achilles tendon rupture repair is described, showing good recovery and early mobility in patients.

## Contribution

A modified Bunnell suture technique with sequential tensioning is introduced for improved functional recovery in Achilles tendon repair.

## Key findings

- The modified technique enabled early weight-bearing and mobilization.
- Patients achieved high ATRS scores (mean: 88.8) indicating good functional outcomes.
- The method preserved the paratenon and reduced wound complications.

## Abstract

Acute Achilles tendon (ATR) rupture is a common and potentially disabling injury, particularly in active young adults. Whilst operative repair offers lower re-rupture rates, traditional open techniques carry risks of wound complications and delayed mobilization. We describe a modified limited-open repair technique incorporating sequential suture tensioning to enhance functional recovery and enable early weight-bearing. Our case series presents five patients (aged 33–46) with acute ATR managed using a lateralised limited-open approach, preserving the paratenon. A modified Bunnell suture technique with FiberTape was applied using three crisscrossed loops, each tensioned sequentially from distal to proximal. Postoperative care included early mobilization and physiotherapy. ATRS scores ranged from 75 to 99 (mean: 88.8). The technique demonstrated biomechanical stability, early recovery, and good outcomes.