Abstract
BackgroundFracture of an ossified Achilles tendon is a rare entity, and no standard treatment has been established. This is the first report to describe the use of a hamstring tendon graft and gastrocnemius fascia flap for Achilles tendon reconstruction.Case presentationWe present the case of a 50-year-old woman with fracture of an ossified Achilles tendon. She presented to our clinic with acute right hindfoot pain, which started suddenly while going up the stairs. Plain radiography and magnetic resonance imaging revealed a massive ossification on the right Achilles tendon extending over 14 cm in length; the ossification was fractured at 5 cm proximal to the calcaneus insertion. Surgical treatment included removal of the ossified tendon and reconstruction with an autologous hamstring tendon graft and gastrocnemius fascia flap. One year after surgery, she was able to walk with little pain or discomfort and to stand on her right tiptoe.ConclusionOur novel surgical procedure may be useful in the treatment of fractured ossified Achilles tendons and large Achilles tendon defects.
Highlights
Fracture of an ossified Achilles tendon is a rare entity, and no standard treatment has been established
Our novel surgical procedure may be useful in the treatment of fractured ossified Achilles tendons and large Achilles tendon defects
We report the case of a fracture of a huge Achilles tendon ossification that was successfully treated by
Summary
Ossification of an Achilles tendon is a rare entity. only a few cases of fracture of an ossified Achilles tendon (FOAT) have been reported [1,2,3,4,5,6,7]. Physical examination revealed diffuse ankle swelling, Achilles tendon stiffness, and moderate tenderness to palpation Despite this discomfort, she could walk stably without a limp and stand on her tiptoes. Radiographs revealed extensive Achilles tendon ossification and osteoarthritis of the ankle joint (Fig. 1a, b). Palpation revealed a severely tender defect 5 cm proximal to the Achilles tendon insertion. She could not stand on her right tiptoe and had a positive Thompson test. After removing muscle tissues attached to the tendons, the tendons were bundled together, and the proximal part of the hamstring tendon graft was tied using a baseball suture technique with 1–0 threads The ends of these threads were passed through the GC fascia and sutured to the proximal Achilles tendon stump (Fig. 4a). The lamellar bones were surrounded by many osteoblasts, suggesting endochondral ossification of the Achilles tendon
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