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Reconstruction of neglected achilles tendon ruptures with gastrocnemius flaps: excellent results in long-term follow-up

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objective

Repair of the neglected achilles tendon ruptures can be challenging due to retraction of tendon stumps. Different repair and augmentation techniques were described. This study aims to investigate long-term results of neglected achilles tendon rupture repair with gastrocnemius flaps.

Patients and methods

Between 1995 and 2005, 21 neglected achilles tendon rupture reconstructions were performed with using gastrocnemius fascial flaps. Mean age was 32.1 years. Mean period between rupture and operation was 8.4 weeks. Ankle range of motion, calf circumference, heel raise test, Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) hindfoot and Foot and Ankle Disability Index (FADI) scores were checked.

Results

The average gap length was 6.4 cm. Mean follow-up was 145.3 months. Median dorsiflexion/plantar flexion values for operated and uneffected sides were 18°/30° and 19°/30°, respectively. The mean values for AOFAS and FADI scores were 98.5 points and 98.9 %, respectively. VAS score was 0 point for all patients. With the numbers available, no significant difference could be detected in terms of ankle range of motion, calf circumference measures and dynamometric analysis. Mean time for return to daily activities was 11.1 (8–16) weeks after surgery. Prerupture activity level was achieved 14.1 months postoperatively. All patients were able to perform heel raise test.

Conclusion

Repair of neglected achilles tendon ruptures with gastrocnemius flaps has satisfactory long-term results.

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References

  1. Maffulli N, Waterston SW, Squair J, Reaper J, Douglas AS (1999) Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med 9:157–160

    Article  CAS  PubMed  Google Scholar 

  2. Gulati V, Jaggard M, Al-Nammari SS, Uzoigwe C, Gulati P, Ismail N, Gibbons C, Gupte C (2015) Management of achilles tendon injury: a current concepts systematic review. World J Orthop 6(4):380–386

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lui TH (2014) A minimally invasive “overwrapping” technique for repairing neglected ruptures of the Achilles tendon. J Foot Ankle Surg 53(6):806–809

    Article  PubMed  Google Scholar 

  4. Padanilam TG (2009) Chronic Achilles tendon ruptures. Foot Ankle Clin 14(4):711–728

    Article  PubMed  Google Scholar 

  5. Takao M, Ochi M, Naito K, Uchio Y, Matsusaki M, Oae K (2003) Repair of neglected Achilles tendon rupture using gastrocnemius fascial flaps. Arch Orthop Trauma Surg 123(9):471–474

    Article  CAS  PubMed  Google Scholar 

  6. Besse J, Lerat J, Moyen B et al (1999) Achilles tendon repair using a bone-tendon graft harvested from the knee extensor system: three cases. J Foot Ankle Surg 38:70–74

    Article  CAS  PubMed  Google Scholar 

  7. Wilcox DK, Bohay DR, Anderson JG (2000) Treatment of chronic Achilles tendon disorders with flexor hallucis longus tendon transfer/augmentation. Foot Ankle Int 21:1004–1010

    CAS  PubMed  Google Scholar 

  8. Us AK, Bilgin SS, Aydin T, Mergen E (1997) Repair of neglected Achilles tendon ruptures: procedures and functional results. Arch Orthop Trauma Surg 116(6–7):408–411

    Article  CAS  PubMed  Google Scholar 

  9. Lindholm A (1959) A new method of operation in subcutaneous rupture of the Achilles tendon. Acta Chir Scand 117:261–270

    CAS  PubMed  Google Scholar 

  10. Scheller A, Kasser J, Quigley T (1980) Tendon injuries about the ankle. Orthop Clin North Am 11:801–811

    CAS  PubMed  Google Scholar 

  11. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353

    Article  CAS  PubMed  Google Scholar 

  12. Hale SA, Hertel J (2005) Reliability and sensitivity of the Foot and Ankle Disability Index in subjects with chronic ankle instability. J Athl Train 40(1):35–40

    PubMed  PubMed Central  Google Scholar 

  13. Nestorson J, Movin T, Moller M et al (2000) Function after Achilles tendon rupture in the elderly: 25 patients older than 65 years followed for 3 years. Acta Orthop Scand 71:64–68

    Article  CAS  PubMed  Google Scholar 

  14. Inglis AE, Scott WN, Sculco TP et al (1976) Ruptures of the tendo Achillis. An objective assessment of surgical and non-surgical treatment. J Bone Jt Surg Am 58:990–993

    CAS  Google Scholar 

  15. Thermann H, Hufner T, Tscherne H (2000) Achilles tendon rupture. Orthopade 29:235–250

    CAS  PubMed  Google Scholar 

  16. Boyden EM, Kitaoka HB, Cahalan TD, An K (1995) Late versus early repair of Achilles tendon rupture. Clin Orthop Relat Res 317:150–158

    PubMed  Google Scholar 

  17. Peterson KS, Hentges MJ, Catanzariti AR, Mendicino MR, Mendicino RW (2014) Surgical considerations for the neglected or chronic Achilles tendon rupture: a combined technique for reconstruction. J Foot Ankle Surg 53(5):664–671

    Article  PubMed  Google Scholar 

  18. Christensen I (1953) Rupture of the Achilles tendon: analysis of 57 cases. Acta Chir Scand 106:50–60

    CAS  PubMed  Google Scholar 

  19. Porter DA, Mannarino FP, Snead D, Gabel SJ, Ostrowski M (1997) Primary repair without augmentation for early neglected Achilles tendon ruptures in the recreational athlete. Foot Ankle Int 18(9):557–564

    Article  CAS  PubMed  Google Scholar 

  20. Uquillas CA, Guss MS, Ryan DJ, Jazrawi LM, Strauss EJ (2015) Everything achilles: knowledge update and current concepts in management: AAOS exhibit selection. J Bone Jt Surg Am 97(14):1187–1195

    Article  Google Scholar 

  21. Maffulli N, Oliva F, Costa V, Del Buono A (2015) The management of chronic rupture of the Achilles tendon: minimally invasive peroneus brevis tendon transfer. Bone Jt J 97-B(3):353–357

    Article  CAS  Google Scholar 

  22. Wegrzyn J, Luciani JF, Philippot R, Brunet-Guedj E, Moyen B, Besse JL (2010) Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. Int Orthop 34(8):1187–1192

    Article  PubMed  Google Scholar 

  23. Myerson MS (1999) Achilles tendon ruptures. Instr Course Lect 48:219–230

    CAS  PubMed  Google Scholar 

  24. Parsons JR, Rosaria A, Weiss AB et al (1989) Achilles tendon repair with an absorbable polymer-carbon fiber composite. Foot Ankle Int 5:179–184

    Article  Google Scholar 

  25. Howard CB, Winston I, Bell W et al (1984) Late repair of the calcaneal tendon with carbon fibre. J Bone Jt Surg Br 66:206–208

    CAS  Google Scholar 

  26. Choksey A, Soonawalla D, Murray J (1996) Repair of neglected Achilles tendon ruptures with Marlex mesh. Injury 27:215–217

    Article  CAS  PubMed  Google Scholar 

  27. Kato YP, Dunn MG, Zawadsks JP et al (1991) Regeneration of Achilles tendon with a collagen tendon prosthesis. J Bone Jt Surg Am 73:561–573

    CAS  Google Scholar 

  28. Liebermann JR, Lozman J, Czajka J et al (1988) Repair of Achilles tendon rupture with Dacron vascular graft. Clin Orthop Relat Res 243:204–208

    Google Scholar 

  29. El Shazly O, Abou El Soud MM, El Mikkawy DM, El Ganzoury I, Ibrahim AM (2014) Endoscopic-assisted achilles tendon reconstruction with free hamstring tendon autograft for chronic rupture of achilles tendon: clinical and isokinetic evaluation. Arthroscopy 30(5):622–628

    Article  PubMed  Google Scholar 

  30. Brumann M, Baumbach SF, Mutschler W, Polzer H (2014) Accelerated rehabilitation following Achilles tendon repair after acute rupture—development of an evidence-based treatment protocol. Injury 45(11):1782–1790

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey

    Ali Seker

  2. Department of Orthopaedics and Traumatology, Medipol Mega Hastane, Istanbul, Turkey

    Adnan Kara

  3. Orthopaedics and Traumatology Clinic, Sisli Etfal Training and Research Hospital, Istanbul, Turkey

    Raffi Armagan, Yunus Oc, Ali Varol & Hasan Basri Sezer

  4. Medipol Mega Hastane, TEM Avrupa Otoyolu Goztepe Cikisi No: 1, Bagcilar, Istanbul, Turkey

    Ali Seker

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  1. Ali Seker
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  2. Adnan Kara
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Correspondence to Ali Seker.

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Seker, A., Kara, A., Armagan, R. et al. Reconstruction of neglected achilles tendon ruptures with gastrocnemius flaps: excellent results in long-term follow-up. Arch Orthop Trauma Surg 136, 1417–1423 (2016). https://doi.org/10.1007/s00402-016-2506-9

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  • DOI: https://doi.org/10.1007/s00402-016-2506-9

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