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Repair of neglected Achilles tendon rupture using gastrocnemius fascial flaps

Abstract

Background.

Neglected Achilles tendon rupture is a rare disorder. In this article, we discuss the results of 10 patients with neglected Achilles tendon ruptures who were treated surgically.

Methods.

Between 1980 and 1997, we treated 10 patients (6 men and 4 women) using gastrocnemius fascial flaps according to the method described by Lindholm. The mean age of the patients at the time of the operation was 51 years (range 38–57 years). They were followed-up for 26–192 months.

Results.

There were significant differences between the American Orthopaedic Foot and Ankle Society (AOFAS) scale score before the operation (72.6±5.3) and the score at the most recent follow-up (98.1±2.5) (p<0.0001). On Cybex isokinetic strength testing, the peak torque deficiencies in plantar flexion ranged from 8% to 68% at the low setting and from 19% to 33% at the high setting preoperatively, and ranged from –9% to 17% at the low setting and from –13% to 23% at the high setting postoperatively. There were no re-ruptures.

Conlusion.

Our data indicate that the reconstructive technique using gastrocnemius fascial flaps can result in an excellent clinical and functional outcome.

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References

  1. Abraham E, Pankovich AM (1975) Neglected rupture of the Achilles tendon: treatment by a V-Y tendinous flap. J Bone Joint Surg Am 57: 253–255

  2. 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

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

  4. Bosworth DM (1956) Repair of defects in the tenoachilles. J Bone Joint Surg Am 38: 111–114

  5. Bugg EI, Boyd BM (1968) Repair of neglected rupture or laceration of the Achilles tendon. Clin Orthop 56: 73–75

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

  7. Gabel S, Manoli A (1994) Neglected rupture of Achilles tendon. Foot Ankle Int 15: 512–517

  8. Gerdes MH, Brown TD, Bell AL, et al (1992) A flap augmentation technique for Achilles tendon repair. Clin Orthop 280: 241–246

  9. Hansen ST Jr (1991) Trauma to the heel cord. In: Jahss MH (ed) Disorders of the foot and ankle. Saunders, Philadelphia, pp 2355–2360

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

  11. Inglis AE, Scott WN, Sculco TP, et al (1976) Ruptures of the tendo achilles: an objective assessment of surgical and nonsurgical treatment. J Bone Joint Surg Am 58: 990–993

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

  13. Kissel CG, Blacklidge DK, Crowley DL (1994) Repair of neglected Achilles tendon ruptures: procedure and functional results. J Foot Ankle Surg 33: 46–52

  14. Kitaoka HB, Alexander IJ, Adelaar RS, et al (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lessor toes. Foot Ankle Int 15: 349–353

  15. Leitner A, Voigt C, Rahmanzadeh R (1992) Treatment of extensive aseptic defects in old Achilles tendon ruptures. Foot Ankle Int 13: 176–180

  16. Levy M, Velkes S, Goldstein J, et al (1984) A method of repair for Achilles tendon ruptures without cast immpbilization. Clin Orthop 187: 199–204

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

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

  19. Lynn TA (1966) Repair of the torn Achilles tendon: using the plantaris tendon as a reinforcing membrane. J Bone Joint Surg Am 48: 268–272

  20. Mann RA, Holmes GB, Seale KS, et al (1991) Chronic rupture of the Achilles tendon: a new technique of repair. J Bone Joint Surg Am 73: 214–219

  21. Mendicino SS, Reed TS (1996) Repair of neglected Achilles tendon ruptures with a triceps surae muscle tendon advancement. J Foot Ankle Surg 35: 13–18

  22. Ozaki J, Fujiki J, Sugimoto K, et al (1989) Reconstruction of neglected Achilles tendon rupture with Marlex mesh. Clin Orthop 238: 204–208

  23. 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

  24. Platt H (1931) Observations of some tendon ruptures. Br Med J 1: 811

  25. Porter DA, Mannarino FP, Snead D, et al (1997) Primary repair without augmentation for early neglected Achilles tendon ruptures in the recreational athlete. Foot Ankle Int 18: 557–564

  26. Ralston E, Schmidt E (1971) Repair of ruptured Achilles tendon. J Trauma 11: 15–21

  27. Teuffer AP (1974) Traumatic rupture of the Achilles tendon. Reconstruction by transplant and graft of the lateral peroneus brevis. Orthop Clin North Am 5: 89–93

  28. Turco VJ, Spinella AJ (1987) Achilles tendon ruptures peroneus brevis transfer. Foot Ankle Int 7: 253–259

  29. Wapner KL, Pavlock GS, Hecht PJ, et al (1993) Repair of chronic Achilles tendon rupture with hallucis longus tendon transfer. Foot Ankle Int 14: 443–449

  30. 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

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Correspondence to M. Takao.

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Takao, M., Ochi, M., Naito, K. et al. Repair of neglected Achilles tendon rupture using gastrocnemius fascial flaps . Arch Orthop Trauma Surg 123, 471–474 (2003). https://doi.org/10.1007/s00402-002-0443-2

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Keywords.

  • Achilles tendon
  • Reconstruction
  • Fascial flaps
  • Gastrocnemius