Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 20, Issue 9, pp 1863–1867 | Cite as

Reconstructive surgery using autologous bone–patellar tendon graft for insertional Achilles tendinopathy

  • Wataru MiyamotoEmail author
  • Masato Takao
  • Takashi Matsushita



The purpose of this study was to investigate the clinical results of reconstructive surgery using a bone–patellar tendon (BPT) autograft for athletes with intractable insertional Achilles tendinopathy.


Ten athletes who underwent reconstructive surgery using a BPT autograft were included in this study. Indications were (1) persistent symptoms in spite of conservative therapy for 6 months, and (2) diffuse high intensity changes of an entire cross-section of the tendon at its insertion point on T2-weighted magnetic resonance imaging (MRI), with clinical follow-up of more than 24 months after surgery. Clinical evaluation was performed before surgery and at the most recent follow-up [median: 32 (25–48) months], and radiological assessment at 1 year after surgery.


The median Achilles tendon rupture score at the most recent follow-up was 92.5 (85–100) points. The median visual analogue scale score improved significantly from 90 (85–100) points preoperatively to 5 (0–10) points at the most recent follow-up (P < 0.01). Based on T2-weighted MRI, the anterior-posterior width of the grafted BPT was approximately twice that of the intact nonsurgical contralateral tendon insertion in all patients at 1 year after surgery. The median time from surgery to ability to return to full sports activity was 13.5 months.


The reconstructive surgery presented in this study can be useful for athletes who suffer from insertional Achilles tendinopathy with a wide area of diseased tendon at the insertion point.

Level of evidence



Reconstruction Autologous tendon graft Bone–patellar tendon Tendinopathy Insertional Achilles tendinopathy 


  1. 1.
    Beavis RC, Rourke K, Court-Brown C (2008) Avulsion fracture of the calcaneal tuberosity: a case report and literature review. Foot Ankle Int 29:863–866PubMedCrossRefGoogle Scholar
  2. 2.
    Benjamin M, Kumai T, Milz S, Boszczyk BM, Boszczyk AA, Ralphs JR (2002) The skeletal attachment of tendons–tendon “entheses”. Comp Biochem Physiol A Mol Integr Physiol 133:931–945PubMedCrossRefGoogle Scholar
  3. 3.
    Besse JL, Lerat JL, Moyen B, Guedj EB (1999) Achilles tendon repair using a bone-tendon graft harvested from the knee extensor system: three cases. J Foot Ankle Surg 38:70–74PubMedCrossRefGoogle Scholar
  4. 4.
    Brown SH, Hentzen ER, Kwan A, Ward SR, Fridén J, Lieber RL (2010) Mechanical strength of the side-to-side versus Pulvertaft weave tendon repair. J Hand Surg Am 35:540–545PubMedCrossRefGoogle Scholar
  5. 5.
    Calder JD, Saxby TS (2003) Surgical treatment of insertional Achilles tendinosis. Foot Ankle Int 24:119–121PubMedGoogle Scholar
  6. 6.
    Den Hartog BD (2009) Insertional Achilles tendinosis: pathogenesis and treatment. Foot Ankle Clin 14:639–650CrossRefGoogle Scholar
  7. 7.
    DeOrio MJ, Easley ME (2008) Surgical strategies: insertional Achilles tendinopathy. Foot Ankle Int 29:542–550PubMedCrossRefGoogle Scholar
  8. 8.
    Ekdahl M, Wang JH, Ronga M, Fu FH (2008) Graft healing in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16:935–947PubMedCrossRefGoogle Scholar
  9. 9.
    Elias I, Raikin SM, Besser MP, Nazarian LN (2009) Outcomes of chronic insertional Achilles tendinosis using FHL autograft through single incision. Foot Ankle Int 30:197–204PubMedCrossRefGoogle Scholar
  10. 10.
    Fahlstrom M, Jonsson P, Lorentzon R, Alfredson H (2003) Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc 11:327–333PubMedCrossRefGoogle Scholar
  11. 11.
    Heckman DS, Gluck GS, Parekh SG (2009) Tendon disorders of the foot and ankle, part 2. Achilles tendon disorders. Am J Sports Med 37:1223–1234PubMedCrossRefGoogle Scholar
  12. 12.
    Irwin TA (2010) Current concepts review: insertional Achilles tendinopathy. Foot Ankle Int 31:933–939PubMedCrossRefGoogle Scholar
  13. 13.
    Jonsson P, Alfredson H, Sunding K, Fahlstrom M, Cook J (2008) New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study. Br J Sports Med 42:746–749PubMedCrossRefGoogle Scholar
  14. 14.
    Kearney R, Costa ML (2010) Insertional Achilles tendinopathy management: a systematic review. Foot Ankle Int 31:689–694PubMedCrossRefGoogle Scholar
  15. 15.
    Khazen GE, Wilson AN, Ashfaq S, Parks BG, Schon LC (2007) Fixation of calcaneal avulsion fractures using screws with and without suture anchors: a biomechanical investigation. Foot Ankle Int 28:1183–1186PubMedCrossRefGoogle Scholar
  16. 16.
    Kolodziej P, Glisson RR, Nunley JA (1999) Risk of avulsion of the Achilles tendon after partial excision for treatment of insertional tendonitis and Haglund’s deformity: a biomechanical study. Foot Ankle Int 20:433–437PubMedGoogle Scholar
  17. 17.
    Krishna Sayana M, Maffulli N (2005) Insertional Achilles tendinopathy. Foot Ankle Clin 10:309–320PubMedCrossRefGoogle Scholar
  18. 18.
    Leppilahti J, Forsman K, Puranen J, Orava S (1998) Outcome and prognostic factors of Achilles rupture repair using a new scoring method. Clin Orthop Relat Res 346:152–161PubMedCrossRefGoogle Scholar
  19. 19.
    Maffulli N, Testa V, Capasso G, Sullo A (2004) Calcific insertional Achilles tendinopathy: reattachment with bone anchors. Am J Sports Med 32:174–182PubMedCrossRefGoogle Scholar
  20. 20.
    Papageorgiou CD, Ma CB, Abramowitch SD, Clineff TD, Woo SL (2001) A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am J Sports Med 29:620–626PubMedGoogle Scholar
  21. 21.
    Park MJ, Lee MC, Seong SC (2001) A comparative study of the healing of tendon autograft and tendon-bone autograft using patellar tendon in rabbits. Int Orthop 25:35–39PubMedCrossRefGoogle Scholar
  22. 22.
    Philippot R, Wegrzyn J, Grosclaude S, Besse JL (2010) Repair of insertional Achilles tendinosis with a bone-quadriceps tendon graft. Foot Ankle Int 31:802–806PubMedCrossRefGoogle Scholar
  23. 23.
    Reddy SS, Pedowitz DI, Parekh SG, Omar IM, Kl Wapner (2009) Surgical treatment for chronic disease and disorders of the Achilles tendon. J Am Acad Orthop Surg 17:3–14PubMedGoogle Scholar
  24. 24.
    Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF (1993) Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 75:1795–1803PubMedGoogle Scholar
  25. 25.
    Tomita F, Yasuda K, Mikami S, Sakai T, Yamazaki S, Tohyama H (2001) Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction. Arthroscopy 17:461–476PubMedCrossRefGoogle Scholar
  26. 26.
    van Dijk CN, van Sterkenburg MN, Wiegerinck JI, Karlsson J, Maffulli N (2011) Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc 19:835–841PubMedCrossRefGoogle Scholar
  27. 27.
    Wagner E, Gould JS, Kneidel M, Fleisig GS, Fowler R (2006) Technique and results of Achilles tendon detachment and reconstruction for insertional Achilles tendinosis. Foot Ankle Int 27:677–684PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Wataru Miyamoto
    • 1
    Email author
  • Masato Takao
    • 1
  • Takashi Matsushita
    • 1
  1. 1.Department of Orthopaedic SurgeryTeikyo University School of MedicineItabashiJapan

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