Revision Achilles Tendon Reconstruction

Abstract

The importance of a functioning Achilles tendon for normal gait underlies the need for adequate reconstruction in the event of problems with repair or initial surgical manipulation. Large segmental Achilles tendon defects present a difficult problem to treating surgeons, and catastrophic failure of the reconstruction can be very intimidating. Multiple procedures including fascial turndowns and allograft reconstruction have been utilized with varying degrees of success. Causes of failure are multifactorial and include poor intraoperative tensioning, postoperative adhesions, infection, and noncompliance with postoperative recovery protocols. After appropriate preoperative workup, the surgeon should be prepared to do an extensive resection of tendon and be prepared for a large defect repair. The benefits of a long turndown flap versus an allograft rebuilding have not been resolved: both procedures offer good results. The turndown flaps work well but require extensive dissection and have risk for significant scar formation. Dual semitendinosus allograft reconstruction offers preservation of the proximal muscle tendon unit and strength.