Fig. 4

Illustration of the peritendium sparring surgical technique. a An incision of approximately 5 cm is placed over the rupture site. The peritendium is reached by careful stump dissection and is kept intact. b A transverse incision is made at the rupture site to expose the rupture. c The tendon stumps are drawn into the transverse incision and two modified Kessler sutures (Fiber-wire®, Arthrex size 2) are used to fix the tendon approximately 4 cm proximal and distal to the transverse incision. d The peritendium is closed with Vicryl, Ethicon 2–0 and the ankle is placed in maximal, unforced plantar flexion before the sutures are tightened maximally, bringing the tendon stumps together inside the peritendium. e A schematic drawing of the double Fiber-wire®, Arthrex size 2 a.m. Kessler with modification in terms of knots proximally on the sides