Surgical Strategy for the Chronic Achilles Tendon Rupture

Abstract

Background. Chronic Achilles tendon rupture is usually misdiagnosed and treated improperly. This study aims to better understand the treatment of chronic Achilles tendon rupture. Methods. Patients who were not able to perform a single-limb heel rise were chosen. Pre- and postoperative magnetic resonance imaging (MRI) were conducted. By evaluating the presence or absence of Achilles tendon stumps and the gap length of rupture, V-Y advancement, gastrocnemius fascial turndown flap, or flexor halluces longus tendon transfer were selected for tendon repair. The function of ankle and foot was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores and Achilles Tendon Total Rupture Score (ATRS). Results. Twenty-nine patients were followed up. One patient had superficial incision infection, which was healed after debridement and oral antibiotics. Three months postoperatively, MRI showed some signs of inflammation, which disappeared at one or two years postoperatively. All patients were able to perform a single-limb heel rise. Mean AOFAS scores and ATRS scores were increased at the latest follow-up. Conclusion. Surgical options can be determined by evaluating the presence of the Achilles tendon stumps and the gap length, which can avoid using the nearby tendon and yield satisfactory functional results.

Outcome of surgical management of ruptured Achilles tendon

“…The other studies also showed the injury was more in male, however involved side varies in different studies. [22][23] The surgical site infection rate in this study was 7/71 (12.67%), higher than others reporting 3% infection. 24 Possible reason could be the less hygienic environment and nutritional status of our patients.…”

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“…Yangjing Lin et al found the surgery to be useful in a maximum gap of 9 cm in length. No serious complications were seen and the AOFS and ATR score showed significant improvement [22] . Ahmad et al deemed that gaps greater than 6 cm in chronic Achilles tendon rupture could be a big challenge to surgeons [23] .…”

“…Another study by Tay et al treated with two turn down flaps and FHL augmentation yielded satisfactory result after a follow up period of two years [24] . Yangjing Lin et al found the surgery to be useful in a maximum gap of 10 cm in length [25] .…”

Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study

“…Rahm et al suggested to perform FHL transfer after failure of local debridement, failure of free tendon grafting in case of a tendon defect or advanced fatty in ltration of the TS. (6) A minimal defect of 50% of the tendon was determined as an indication for the need of a tendon transfer by several authors (7,10,11,24) Lin et al (25) presented an algorithm for the treatment of chronic Achilles tendinopathy based on the presence or absence of stumps on preoperative MRI and the defect gap measured intra-operatively. FHL transfer was considered when the tendon stumps did not have enough integrity.…”