02/14/2013 08:40 am ET Updated Apr 16, 2013

Senators Erik Karlsson's Sliced Achilles: How Bad of an Injury Is It Really?

A sliced Achilles tendon is something that one would expect to see in a horror movie, not on an ice skating rink. Unfortunately for Ottawa Senators defenseman Erik Karlsson, his Achilles was cut by the blade of a skate while being hit against the boards.

Reports are already indicating that he will need surgery. Sure, but what's involved in an Achilles laceration repair?

When most hear about Achilles injury surgery, they immediately think of the repair of a ruptured Achilles from a forced event where the Achilles literally tears and shreds into pieces. These Achilles ruptures occur in the midsubstance of the tendon. Those injuries occur, most commonly a few centimeters above the heel bone, and the repair is straight forward -- run a suture up and down the tendon and tie one tendon end to the other tendon end. Karlsson's injury is not exactly that.

Closely watching the replay, the skate hit his lower leg, at what appears to be the highest aspect of the Achilles, where the calf muscles are just forming the Achilles. Briefly, the Achilles tendon is formed from two separate lower leg muscles -- the gastrocmenius (more superficial) and the soleus (deeper). Together these muscles coalesce to become the Achilles.

In the region where Karlsson appears to be injured, the Achilles is more sheet-like in nature, rather than tubular. Injuries really high up may involve the muscle. The reason this is important is because repairs in that region can be challenging to repair the sheet-like tendon ends, and more so when an injury is at the muscle interface. What's in his favor, is that a laceration (unlike a rupture) typically makes a straight cut rather than a shredded tear, making the repair zone easily distinguished.

Interestingly, foot surgeons often find the Achilles tendon complex to be too tight when associated with flat feet. In many routine flat foot reconstructive surgeries, surgeons often purposefully surgical transect the Achilles or Gastrocnemius muscle to lengthen the tendon for these flat footed patients. While this is not the case for Karlsson, it is likely that this injury will not impact his long-term function.

-- Dr. Neal Blitz
New York City

To learn more about Dr. Neal Blitz, please visit