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

Abstract

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. IV.