Abstract
Purpose
A rupture of the Achilles tendon may heal in continuity, resulting in a lengthened Achilles tendon. The elongated structure must be shortened to restore effective push off. We report the results of a longitudinal study using Z-shortening of ruptured Achilles tendons that healed in continuity but were elongated.
Methods
Nine patients underwent surgery for elongation of a healed Achilles tendon rupture. All participants were prospectively followed up for two to five years, and final review was performed at 32 ± 14 months from operation. Clinical and functional assessment (anthropometric measurements, isometric strength, postoperative total rupture score) was performed.
Results
All patients were able to walk on tiptoes, and no patient used a heel lift or walked with a visible limp. No patient developed clinically evident deep-vein thrombosis or sustained a rerupture. Two patients were managed conservatively following a superficial surgical wound infection. At final review, maximum calf circumference remained significantly decreased in the operated leg. The operated limb was significantly weaker than the nonoperated one.
Conclusions
Managing a healed Achilles tendon rupture using Z-shortening is safe and effective, providing good recovery and early weight bearing and active ankle mobilisation. Such patients should be warned that they are at risk for postoperative complications and that their ankle–plantar flexion strength is likely to be permanently reduced.
Similar content being viewed by others
References
Jozsa L, Kvist M, Balint BJ, Reffy A, Jarvinen M, Lehto M, Barzo M (1989) The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases. Am J Sports Med 17:338–43
Maffulli N (1996) Clinical tests in sports medicine: more on Achilles tendon. Br J Sports Med 30:250
Platt H (1931) Observations of some tendon ruptures. Br Med J 1:811
Maffulli N, Ajis A, Longo UG, Denaro V (2007) Chronic rupture of tendo Achillis. Foot Ankle Clin 12:583–96
Cannon LB, Hackney RG (2003) Operative shortening of the elongated defunctioned tendoachillies following previous rupture. J R Nav Med Serv 89:139–41
Carmont MR, Maffulli N (2009) Z shortening of healed Achilles tendon rupture: a technical note. Foot Ankle Int 30:704–7
Maffulli N (1998) The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med 26:266–70
Simmonds FA (1957) The diagnosis of the ruptured Achilles tendon. Practitioner 179:56–8
Matles AL (1975) Rupture of the tendo Achilles. Another diagnostic sign. Bull Hosp Joint Dis 36:48–51
Maffulli N, Tallon C, Wong J, Lim KP, Bleakney R (2003) Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon. Am J Sports Med 31:692–700
Maffulli N, Tallon C, Wong J, Peng Lim K, Bleakney R (2003) No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon. J Sports Med Phys Fitness 43:367–79
Nilsson-Helander K, Thomee R, Gravare-Silbernagel K, Thomee P, Faxen E, Eriksson BI, Karlsson J (2007) The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med 35:421–6
Boyden EM, Kitaoka HB, Cahalan TD, An KN (1995) Late versus early repair of Achilles tendon rupture. Clinical and biomechanical evaluation. Clin Orthop Relat Res 317:150–8
Pintore E, Barra V, Pintore R, Maffulli N (2001) Peroneus brevis tendon transfer in neglected tears of the Achilles tendon. J Trauma 50:71–8
Bleakney RR, Tallon C, Wong JK, Lim KP, Maffulli N (2002) Long-term ultrasonographic features of the Achilles tendon after rupture. Clin J Sport Med 12:273–8
Webb J, Moorjani N, Radford M (2000) Anatomy of the sural nerve and its relation to the Achilles tendon. Foot Ankle Int 21:475–7
Karousou E, Ronga M, Vigetti D, Passi A, Maffulli N (2008) Collagens, proteoglycans, MMP-2, MMP-9 and TIMPs in human achilles tendon rupture. Clin Orthop Relat Res 466:1577–82
Hamilton B, Remedios D, Loosemore M, Maffulli N (2008) Achilles tendon rupture in an elite athlete following multiple injection therapies. J Sci Med Sport 11:566–8
Thordarson D (2006) Immediate full weight-bearing mobilization was better than immobilization after operative repair of a ruptured achilles tendon. J Bone Joint Surg Am 8:1894
Sharma P, Maffulli N (2005) Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am 87:187–202
Competing interests
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Maffulli, N., Spiezia, F., Longo, U.G. et al. Z-shortening of healed, elongated Achilles tendon rupture. International Orthopaedics (SICOT) 36, 2087–2093 (2012). https://doi.org/10.1007/s00264-012-1602-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-012-1602-x