Repair of neglected Achilles tendon ruptures: procedures and functional results

Abstract

Surgical repair of neglected Achilles tendon ruptures presents the challenge of restoring the function of the Achilles tendon complex while repairing the large defect that is created by the delay in appropriate treatment. We present our preferred technique for delayed repair and the results of six patients who were available for complete follow-up evaluation. The combined surgical technique includes: V-to-Y gastrocnemius recession or advancement, excision of the fibroadipose defect, end-to-end anastomosis, gastrocnemius aponeurotic flap to reinforce the anastomosis. Each of six patients were interviewed and examined clinically and by Cybex II isokinetic strength testing. All six patients have been able to return to their pre-injury activities. Cybex II isokinetic strength testing demonstrated peak torque deficiencies in plantar flexion ranging from 2.5%-22% as compared with the unaffected limb. The overall results of the technique described indicate that very satisfactory functioning of a neglected Achilles tendon rupture can be obtained.

Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer

“…No hyperextension of the hallux interphalangeal joint occurred. For functional outcome, our results were close to those reported by other authors [8,12,21,24,26,27].…”

“…Taking into account all surgical procedures, the incidence of AT re-rupture following acute or chronic rupture reconstruction has been reported to be 1.4-3.7% [4,25]. However, in our study and other previous series, when using FHL tendon transfer for AT chronic rupture reconstruction, no case of re-rupture has been reported at latest follow-up [8,12,21,24,26,27].…”

“…Other surgical techniques used tendon transfer of peroneus brevis (PB) [22], flexor digitorum longus (FDL) [17] or flexor hallucis longus (FHL) [10] tendon. All these surgical procedures have been shown to yield satisfactory clinical results, although ankle plantar flexion strength and peak torque deficits persisted [1,2,10,17,21,24].…”

Medial Achilles tendon island flap—a novel technique to treat reruptures and neglected ruptures of the Achilles tendon

“…Later, Arner and Lindholm [19] modified the technique and used two flaps instead of one, while Silfverskiöld [6] used one rotated flap in order to ensure that the smooth tendon surface faced the skin and to reduce the risk of skin adhesions. The use of a turn down flap has also been described in combination with a V to Y lengthening in six patients [20]. The functional results of these techniques appears to be acceptable but the major drawback from our point of view is the large bulky mass of tissue over the rupture site causing an increased tension to the overlying skin and subsequent wound healing problems.…”

Chronic Achilles Tendon Rupture Reconstruction Using the Lindholm Method and the Vulpius Method

“…The optimal treatment of chronic Achilles tendon rupture is surgical repair [ 5 , 6 ] and various techniques have been described [ 3 , 6 , 7 ]. It is difficult to treat a chronically ruptured Achilles tendon because there usually is a gap between the ends of the tendon, scarring, retraction of calf muscles and loss of contractility of the triceps surae [ 3 , 5 , 8 ]. These problems make the treatment of chronic Achilles tendon ruptures different from that of acute ruptures [ 5 , 8 , 9 ].…”