In this The Sports Docs Podcast episode, Dr. Ashley Bassett and Dr. Catherine Logan sit down with foot and ankle experts Dr. David Pedowitz and Dr. Josh Metzl.

From evolving surgical techniques to implant innovation and accelerated return-to-play timelines, this conversation highlights how modern approaches are reshaping outcomes for high-level athletes.

Achilles Tendon Injuries

Who Needs Surgery?

Best suited for young, active athletes, especially in explosive or cutting sports
While nonoperative care has improved:
- Tendon elongation remains a key concern
- Push-off strength deficits can impact performance
Surgical repair offers:
- Faster strength recovery
- More predictable return to sport

Evolution of Surgical Technique

Shift from open surgery → minimally invasive (MIS) and percutaneous approaches
Benefits:
- ↓ wound complications
- Improved cosmesis
- Faster rehabilitation
Double-row fixation restores native footprint and improves gap resistance

PARS Technique (Percutaneous Achilles Repair System)

Combines precision of open repair with less soft tissue disruption
Key features:
- Small incision with percutaneous suture passage
- Reproducible jig-guided technique
- Strong, locking suture construct
Ideal for acute midsubstance ruptures

Pearls:

Master jig orientation before live cases
Maintain tension during suture passage
Protect the sural nerve

Pitfalls:

Incisions too small → poor visualization
Overtensioning the repair

Repair Constructs: PARS vs SpeedBridge

SpeedBridge (double-row, knotless):
- ↓ tendon elongation
- Strong biomechanical construct
- Slight ↑ risk of heel pain
PARS:
- Less invasive
- Lower wound complication rates

Insertional Achilles Pathology

Typically treated with open or MIS SpeedBridge techniques
MIS FiberTak SpeedBridge advantages:
- Smaller incisions
- Less implant material
- Strong fixation with rip-stop construct
- Supports early weight-bearing and mobilization

Return to Play

90% return to sport after surgery
Typical timeline:
- Running: progressive, athlete-specific
- Full return: ~6–9 months

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Arthrex Team Physician Controversies 2026

Our Hosts:

Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com