Good outcomes at mid-term following the reconstruction of chronic Achilles tendon rupture with semitendinosus allograft

  • Yu-Jie Song
  • Gang Chen
  • Shao-Hua Jia
  • Wei-Bin Xu
  • Ying-Hui HuaEmail author



Chronic Achilles tendon rupture is commonly treated surgically, yet there are limited available data on tendon allografts for Achilles tendon reconstruction. The purpose of this study was to evaluate the patient-reported outcomes of chronic Achilles tendon rupture reconstructed with semitendinosus allograft.


A total of 34 patients (30 males and 4 females, average age 36.1 ± 6.8 years ranging from 25 to 50 years) who underwent Achilles tendon reconstruction with semitendinosus allograft from 2011 to 2015 were identified for this retrospective study. The American Orthopedic Foot and Ankle Society (AOFAS) score, Victorian Institute of Sports Assessment-Achilles (VISA-A) score, Achilles tendon total rupture score (ATRS), and Tegner score were evaluated preoperatively and at final follow-up.


A total of 33 patients (97.1%) were followed up for a median time of 53 (range 24–80) months. The median AOFAS score increased from 50 (5–75) to 100 (86–100), the median VISA-A score increased from 23 (5–59) to 94 (52–100), the median ATRS score increased from 22.5 (6–67) to 99 (84–100), and the median Tegner score increased from 1 (0–3) to 4 (3–9).


Reconstruction of chronic-ruptured Achilles tendon with semitendinosus allograft offers satisfactory patient-reported results with low risk of re-rupture and complications. This technique could be considered an effective alternative for chronic ruptures of the Achilles tendon.

Level of evidence

Case series, Level IV.


Achilles tendon Chronic rupture Reconstruction Semitendinosus tendon allograft 



No funding was received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All authors certify that this investigation was performed in conformity with ethical principles of research. Written informed consent was obtained from each participant, and the institutional review board was approved by the Huashan Hospital Affiliated to Fudan University.


  1. 1.
    Abraham E, Pankovich AM (1975) Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap. J Bone Joint Surg Am 57:253–255CrossRefPubMedGoogle Scholar
  2. 2.
    Asselmeier MA, Caspari RB, Bottenfield S (1993) A review of allograft processing and sterilization techniques and their role in transmission of the human immunodeficiency virus. Am J Sports Med 21:170–175CrossRefPubMedGoogle Scholar
  3. 3.
    Aynardi MC, Atwater LC, Melvani R, Parks BG, Paez AG, Miller SD (2017) Is dual semitendinosus allograft stronger than turndown for Achilles tendon reconstruction? An in vitro analysis. Clin Orthop Relat Res 475:2588–2596CrossRefPubMedGoogle Scholar
  4. 4.
    Buck BE, Resnick L, Shah SM, Malinin TI (1990) Human immunodeficiency virus cultured from bone. Implications for transplantation. Clin Orthop Relat Res 251:249–253Google Scholar
  5. 5.
    Carden DG, Noble J, Chalmers J, Lunn P, Ellis J (1987) Rupture of the calcaneal tendon. The early and late management. J Bone Joint Surg Br 69:416–420CrossRefPubMedGoogle Scholar
  6. 6.
    Dierckman BD, Ferkel RD (2015) Anatomic reconstruction with a semitendinosus allograft for chronic lateral ankle instability. Am J Sports Med 43:1941–1950CrossRefPubMedGoogle Scholar
  7. 7.
    Guclu B, Basat HC, Yildirim T, Bozduman O, Us AK (2016) Long-term results of chronic Achilles tendon ruptures repaired with V-Y tendon plasty and fascia turndown. Foot Ankle Int 37:737–742CrossRefPubMedGoogle Scholar
  8. 8.
    Hua Y, Chen S, Jin Y, Zhang B, Li Y, Li H (2012) Anatomical reconstruction of the lateral ligaments of the ankle with semitendinosus allograft. Int Orthop 36:2027–2031CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ibrahim SA (2009) Surgical treatment of chronic Achilles tendon rupture. J Foot Ankle Surg 48:340–346CrossRefPubMedGoogle Scholar
  10. 10.
    Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK (2007) Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg 46:65–74CrossRefPubMedGoogle Scholar
  11. 11.
    Jackson DW, Grood ES, Goldstein JD, Rosen MA, Kurzweil PR, Cummings JF, Simon TM (1993) A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med 21:176–185CrossRefPubMedGoogle Scholar
  12. 12.
    Ji JH, Kim WY, Kim YY, Lee YS, Yoon JS (2016) Semitendinosus tendon augmentation for a large defect after Achilles tendon rupture: two case reports. Foot Ankle Int 28:1100–1103CrossRefGoogle Scholar
  13. 13.
    Kearney RS, Costa ML (2010) Collagen-matrix allograft augmentation of bilateral rupture of the achilles tendon. Foot Anke Int 31:556–559CrossRefGoogle Scholar
  14. 14.
    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 15:349–353CrossRefPubMedGoogle Scholar
  15. 15.
    Li Q, Ma K, Tao H, Hua Y, Chen S, Chen S, Zhao Y (2018) Clinical and magnetic resonance imaging assessment of anatomical lateral ankle ligament reconstruction: comparison of tendon allograft and autograft. Int Orthop CrossRefPubMedGoogle Scholar
  16. 16.
    Maffulli N, Ajis A (2008) Management of chronic ruptures of the Achilles tendon. J Bone Joint Surg Am 90:1348–1360CrossRefPubMedGoogle Scholar
  17. 17.
    Maffulli N, Longo UG, Gougoulias N, Denaro V (2008) Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon. BMC Musculoskelet Disord 9:100CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Malinin TI, Levitt RL, Bashore C, Temple HT, Mnaymneh W (2002) A study of retrieved allografts used to replace anterior cruciate ligaments. Arthroscopy 18:163–170CrossRefPubMedGoogle Scholar
  19. 19.
    Muller SA, Evans CH, Heisterbach PE, Majewski M (2018) The role of the paratenon in Achilles tendon healing: a study in rats. Am J Sports Med 46:1214–1219CrossRefPubMedGoogle Scholar
  20. 20.
    Nilsson-Helander K, Thomeé R, Grävare-Silbernagel K, Thomeé P, Faxén E, Eriksson BI, Karlsson J (2017) The Achilles tendon total rupture score (ATRS). Am J Sports Med 35:421–426CrossRefGoogle Scholar
  21. 21.
    Patil SD, Patil VD, Basa VR, Dombale AB (2014) Semitendinosus tendon autograft for reconstruction of large defects in chronic Achilles tendon ruptures. Foot Ankle Int 7:699–705CrossRefGoogle Scholar
  22. 22.
    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 18:557–564CrossRefPubMedGoogle Scholar
  23. 23.
    Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, Taunton JE, Khan KM (2001) The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 35:335–341CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Sarzaeem MM, Lemraski M, Safdari F (2012) Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer. Knee Surg Sports Traumatol Arthrosc 20:1386–1391CrossRefPubMedGoogle Scholar
  25. 25.
    Song Y, Hua Y (2018) Tendon allograft for treatment of chronic Achilles tendon rupture: a systematic review. Foot Ankle Surg. CrossRefGoogle Scholar
  26. 26.
    Su EP, Healey JH (2003) Salvage reconstruction for lateral ankle instability using a tendon allograft. Clin Orthop Relat Res 415:232–238CrossRefGoogle Scholar
  27. 27.
    Takeuchi M, Suzue N, Matsuura T, Higashino K, Sakai T, Hamada D, Goto T, Takata Y, Nishisho T, Goda Y, Sato R, Tonogai I, Mineta K, Sairyo K (2014) Reconstruction of chronic Achilles tendon rupture using the semitendinosus tendon: a case report. J Med Invest 61:417–420CrossRefPubMedGoogle Scholar
  28. 28.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49Google Scholar
  29. 29.
    Wu Z, Hua Y, Li H, Chen S, Li Y (2015) Biomechanical comparison of three methods for distal Achilles tendon reconstruction. Knee Surg Sports Traumatol Arthrosc 23:3756–3760CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Sports Medicine, Huashan HospitalFudan UniversityShanghaiChina
  2. 2.Department of OrthopedicsThe Second Affiliated Hospital of Jiaxing UniversityZhejiangChina

Personalised recommendations