Abstract
Objective of the study is to find out functional outcome and complications associated with surgical reconstruction of chronic degenerative tendoachilles rupture using peroneus brevis tendon and role of local steroid injection in chronic rupture of tendon. We studied 10 cases with chronic degenerative Achilles tendon rupture who were treated with peroneus brevis tendon augmentation procedure. In 8 cases rupture of tendon was secondary to local corticosteroid injection given for retro calcaneal bursitis. Patients came to hospital with pain over the Achilles tendon and difficulty in walking, climbing stairs, diagnosed of Achilles tendon rupture through physical examination and subjected to USG for confirmation. Patients have undergone operative treatment in the form end to end suturing of ruptured tendon using Krakow technique and augmentation of tendon using peroneus brevis tendon as explained by Teuffer. Post operatively patient immobilized in above knee cast with foot in 15-20 plantar flexion and 45 degree of knee flexion. Suture removal done after 14 days of surgery. After 4 weeks cast converted to short leg cast. Mobilization started after 6 weeks on the cast. Cast discontinued after 8 weeks and full weight bearing started at 8-12 weeks. Follow up done for 18 months. Of 10 patients 7 patients were male and 3 were female. Age range was 30-60 years with mean age of 45 years. 7 patients had right tendon rupture, 3 had left tendon rupture. 8 patients gave previous history of corticosteroid injection given for retro calcaneal bursitis. Postoperatively 2 patients had skin necrosis which healed by secondary intention and scar. According to AOFAS scoring system for functional outcome of patients increased from preoperatively 65 to postoperatively 95(range 90-100). There is increased risk of Achilles tendon rupture after local steroid injection for inflammatory lesions of tendon or around the tendon, so it’s better to avoid giving local steroid injections in or around the Achilles tendon. Peroneus brevis can be easily used for Achilles tendon augmentation with good functional outcome. Keywords: Achilles tendon rupture, peroneus brevis tendon, corticosteroid, Teuffers technique, AOFAS scoring system.
Highlights
Injuries of Achilles tendon are relatively common in middle aged athletes and account for third most common tendon to be ruptured[1]
Tuberosity of calcanuem is dissected and drill hole is made for passing peroneus brevis tendon
Various causes have been explained for chronic degenerative tendoachilles tear like side effects of gout, hyperparathyroidism, steroids and fluoroquinolones[7]
Summary
Injuries of Achilles tendon are relatively common in middle aged athletes and account for third most common tendon to be ruptured[1]. Degenerative ruptures of tendoachilles typical in patients after the age of 30 years. The Achilles tendon has no true synovial sheath, it is covered only by a para tenon and exogenous healing (from synovial fluid) is not expected to occur[4]. In the past, this injury was treated with end to end suturing and a plaster cast, but this was associated with high rates ofreruptures and weakened push off. We investigated clinical outcome of ten patients treated with reconstruction of Achilles tendon using peroneus brevis
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