Installation in the ventral decubitus with the foot outside the table so as to be able to manipulate the talocrural freely (flexion-extension).

Marking the rupture:
Location of the rupture area by palpitation, possibly marking out with a dermographic pencil and shaping the needle to the desired curvature.

Proximal incision:
The proximal incision, 2cm long, is made 6cm above the rupture on the inside edge of the tendon in order to avoid the external  saphena nerve.

Proximal box:
Creation of a point in a box on the proximal part of the tendon.

Passage of the needle:
Insertion of the needle into the thickness of the tendon, guiding it along the tendon’s axis across the rupture up to the distal fragment. The needle’s position and its progress can be constantly controlled by palpitation of the tendon.

Distal box:
Creation of a point in a box on the lower fragment by two tiny incisions in this particularly difficult scarring area after checking the tendon crests are opposite each other and there is good tension in the ligament.

Return of the needle:
Return of the needle through the thickness of the tendon to the point in the initial box.

Tightening:
Set the foot in the equinus position until the ruptured tendon fibres are in confrontation, checked by  palpation.

Upper knot:
Production of the final knot with or without support from the pad provided for this purpose The large size of the pad’s convex face enables the pressure to be homogenised. Use of the pad can be avoided and the thread knotted directly. The thread’s large diameter enables it to be re-pierced to facilitate the knotting operation.