PMC7728476_01
The gift box technique. Free suture ends passed across the rupture site to the opposite side of tendon and tied distal to the crossover stitch of the other suture (reproduced with permission from Sage Publishers, Adapted from Labib SA, Rolf R, Dacus R, Hutton WC. The "Giftbox" Repair of the Achilles Tendon: A Modification of the Krackow Technique. Foot & Ankle International 2009, 30(5)  : 410-414).
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Sutures were passed proximal and distal to the Krackow stitches, using the gift box technique and tied with the ankle held in maximal plantar flexion (Figure 1).
Intraoperative photograph of open rerupture of the achilles tendon. Axis of the wound is transverse and perpendicular to the original surgical incision.
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A 2 cm transverse laceration over his prior Achilles rupture site was noted, with an underlying rerupture of the Achilles tendon at the same level (Figure 2).
Revision surgical intervention utilizing minimally invasive jig to pass sutures through the proximal Achilles stump.
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A percutaneous jig (Arthrex, Inc., Naples, FL) was utilized in accordance with the PARS  midsubstance Achilles repair technique through the open transverse laceration (Figure 3).
Sutures being passed from proximal Achilles through distal tendon stump with suture lasso to be anchored in the calcaneus.
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Sutures from the proximal Achilles stump were passed through the distal tendon with a lasso and secured into the calcaneus using swivel lock anchors  (Arthrex, Inc., Naples, FL) with the ankle held in plantar flexion (Figure 4).
Six months postoperative visit from revision surgery.
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