Ultrasound tracks the tendon and the needle, bringing the surgical wound down from over 8 centimeters to around 0.8 to 1 centimeter while protecting the surrounding nerves and vessels.
Open repair of a ruptured Achilles tendon leaves a wound of 8 to 14 centimeters. Chen-Chie Wang, Director of the Department of Orthopedic Surgery at Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, leads a team that uses ultrasound-guided minimally invasive repair to bring that wound down to roughly 0.8 to 1 centimeter.
Locating the tendon through so small an incision is the technical heart of the procedure. Ultrasound shows the team where the tendon has torn and where the needle sits, supporting the repair while protecting the surrounding nerves and vessels.
Ultrasound-guided minimally invasive Achilles tendon repair combines tendon imaging with the suturing itself. The image shows the site of the rupture and the relationship between the needle and the tendon, and that is what the surgeon navigates by.
The procedure depends heavily on that guidance. With a smaller incision, the team relies on imaging to know exactly where it is working, completing the repair through a limited incision.
In 2012 the team published Ultrasound-Guided Minimally Invasive Surgery for Achilles Tendon Rupture: Preliminary Results in Foot & Ankle International, reporting the early results of the technique. Clinical cases have accumulated since, alongside related minimally invasive foot and ankle procedures.
Ultrasound guidance has since been extended to ruptures at the calcaneal insertion of the Achilles tendon, and to retrocalcaneal bursitis.
All three procedures share the same guidance, but treat different lesions with different goals: Achilles ruptures and insertional ruptures are repaired, while retrocalcaneal bursitis is debrided. The team has published on each, building clinical experience across the different presentations.
What distinguishes the technique, then, is not only the small incision but the way ultrasound localisation is applied to different foot and ankle lesions, each paired with the repair or debridement it needs.
As of January 2026, more than 400 patients had been treated, with an operative time of approximately 30 minutes, wound complication rate of 0.9%, a tendon re-tear rate of less than 1%, and functional recovery in approximately 3 months.
The team has also established assessment protocols, quality management and post-operative data tracking, with cross-specialty collaboration before, during and after surgery. Beyond wound size, it follows wound healing, re-rupture and functional recovery.
Surgical education uses cadaveric simulation and video demonstration. The team hosts and co-hosts foot and ankle cadaveric workshops, produced teaching videos for Taiwan's foot and ankle orthopaedic society, and promotes the technique overseas together with the TendMIN system.
The first use of this Taiwan-developed procedure in the United States was completed in Boston in October 2024; as of January 2026, more than 170 physicians there had been trained and more than 90 cases performed.
Department of Orthopedic Surgery, Taipei Tzu Chi Hospital - overseas adoption
