Chronic Rupture Research Articles

"The Chambat Sardine Can" technique for the treatment of chronic quadriceps tendon rupture.

Ruptures of the quadriceps tendon (QT) are rare but serious injuries accounting for less than 2% of all tendon injuries around the knee. These injuries, often occurring in individuals over 40, are leading to a loss of active extension and a significant impact on knee function. While the treatment of acute QT ruptures through various reinsertion techniques has shown excellent outcomes, managing chronic injuries and failed primary repairs remains challenging due to tendon retraction and difficulties in repositioning the tendon stump. This study introduces a novel approach associating direct tendon reinsertion with metal frame reinforcement, aiming to effectively lower the retracted tendon to the proximal pole of the patella. This technique offers a promising alternative that addresses the limitations of traditional methods and potentially improves patient outcomes by providing a safe primary fixation and protection of the repair, enabling early rehabilitation and reducing the need for subsequent interventions. LEVEL OF EVIDENCE: IV; case series study.

Direct repair of the chronic ochronotic Achilles tendon rupture: a case report

BackgroundAlkaptonuria (AKU) is a rare hereditary disease. Ochronotic arthropathy, tendinopathy, and osteopenia/osteoporosis are generally musculoskeletal manifestations in patients with AKU. Because of the ochronotic tendinopathy and osteopenia, the surgical strategy for chronic ochronotic Achilles tendon rupture may be challenging. No studies have reported the surgical treatment of chronic Achilles tendon rupture in patients with AKU.Case presentationWe report a case of AKU that required surgical treatment for chronic Achilles tendon rupture. A 60-year-old woman was referred to our department for the assessment of left hindfoot pain that persisted for more than nine months after an ankle sprain. Three years prior to the first presentation to our hospital, she was diagnosed with AKU due to pigmented hip cartilage at the time of total hip arthroplasty. The patient was diagnosed as chronic Achilles tendon rupture based on the results of physical examination and magnetic resonance imaging (MRI). The MRI showed enlarged scar tissue of the Achilles tendon with an intrasubstance high signal intensity. We performed resection of the central part of the scar tissue (total length, 24 mm) followed by direct repair using the proximal and distal stumps of the scar tissue. The MRI at 12months after surgery showed continuity of the repaired Achilles tendon. At 18 months after surgery, the Achilles Tendon Total Rupture Score improved from 22 points preoperatively to 84 points postoperatively. The foot and ankle outcome score also improved.ConclusionsWe reported a case of AKU with chronic Achilles tendon rupture in which direct repair using scar tissue between the tendon stumps was effective. Careful selection of the surgical procedure for the treatment of chronic ochronotic Achilles tendon rupture is recommended because of concomitant ochronotic tendinopathy and osteopenia/osteoporosis.

THE FORTH VALLEY ACHILLES MANAGEMENT PROTOCOL FOR ACUTE ACHILLES TENDON RUPTURES: A PROSPECTIVE OBSERVATIONAL STUDY

This prospective study explores the outcomes of the Forth Valley Protocol (FVP) for the management of acute Achilles tendon ruptures. The protocol uses ultrasound as the primary mechanism to guide treatment.All patients presenting with acute tendoachilles rupture over a three-year period were included. Patients under 18 years of age, chronic ruptures, or prior surgery to the Achilles tendon were excluded. Patients with a gap ≤2cm had conservative management following an Early Rehabilitation Protocol (ERP) and >2cm underwent surgery (if an appropriate surgical candidate). Achilles Tendon Rupture Scores (ATRS) were obtained retrospectively. Fischer's exact test was used to determine statistical significance.158 patients were included with a mean age of 53 (range 20–89). Ultrasound scans were obtained for 121 patients (76.5%), demonstrating a mean tendon gap of 1.61cm. 143 patients managed conservatively and 15 surgically. The overall re-rupture rate was 3.8% (n=6). All the re-ruptures occurred in patients treated conservatively, but this was not found to be statistically significant (n=6, P=1.0). The overall complication rate (excluding re-ruptures) was 1.9%. ATRS was comparable between both treatment modalities (P=0.382, 0.422), with a mean score of 86.6 in the conservative group and 81.4 in the surgical group.The FVP demonstrates low re-rupture and complication rates in line with other published studies. Patients with gaps ≤2.0cm on the ultrasound can be successfully treated conservatively with an ERP. This has potential benefits in terms improved patient outcomes, satisfaction, and preservation of resources.

Patellar Tendon Reconstruction Using Quadriceps, Semitendinosus, and Gracilis Autografts With Ultra-high Molecular Weight Polyethylene Tape Augmentation: A Novel Technique

Background: Chronic patellar tendon ruptures are challenging injuries to treat and can be debilitating to patients. Optimal treatment of these extensor mechanism injuries occurs in the acute postinjury period. When these injuries become chronic, they are increasingly difficult to treat effectively. Purpose: We present a case of chronic patellar tendon rupture in a young athletic male who was treated with quadriceps, semitendinosus, and gracilis autograft. To our knowledge, there have been no other reports of using a quadriceps autograft with a bone plug to reconstruct a chronic patellar tendon injury. Patients and Methods: A healthy male under the age of 18 presented in a delayed manner to our clinic with complaints of left knee pain and inability to straighten the knee. His imaging and clinical exam found that he had a patellar tendon rupture, ∼15-degree extensor lag, flexion to 140 degrees, and was unable to straight leg raise or perform any active extension of the knee. He had significant atrophy of his vastus musculature at the knee. The rupture was treated with quadriceps, semitendinosus, and gracilis autograft. Results: At 6 months follow-up, our patient had achieved full extension, flexion to 135 degrees, and 4 of 5 quadriceps strength. He returned to routine physical activity and was satisfied with his results to date. At 1 year’s follow-up, the patient had full extension and flexion to 140 degrees and had resumed playing recreational soccer. Conclusion: Treating chronic patellar tendon rupture with quadriceps, semitendinosus, and gracilis autograft resulted in a positive outcome for this difficult-to-treat injury.

Enhancing osteogenic differentiation of diabetic tendon stem/progenitor cells through hyperoxia: Unveiling ROS/HIF-1α signalling axis.

Diabetic calcific tendinopathy is the leading cause of chronic pain, mobility restriction, and tendon rupture in patients with diabetes. Tendon stem/progenitor cells (TSPCs) have been implicated in the development of diabetic calcified tendinopathy, but the molecular mechanisms remain unclear. This study found that diabetic tendons have a hyperoxic environment, characterized by increased oxygen delivery channels and carriers. In hyperoxic environment, TSPCs showed enhanced osteogenic differentiation and increased levels of reactive oxygen species (ROS). Additionally, hypoxia-inducible factor-1a (HIF-1a), a protein involved in regulating cellular responses to hyperoxia, was decreased in TSPCs by the ubiquitin-proteasome system. By intervening with antioxidant N-acetyl-L-cysteine (NAC) and overexpressing HIF-1a, we discovered that blocking the ROS/HIF-1a signalling axis significantly inhibited the osteogenic differentiation ability of TSPCs. Animal experiments further confirmed that hyperoxic environment could cause calcification in the Achilles tendon tissue of rats, while NAC intervention prevented calcification. These findings demonstrate that hyperoxia in diabetic tendons promotes osteogenic differentiation of TSPCs through the ROS/HIF-1a signalling axis. This study provides a new theoretical basis and research target for preventing and treating diabetic calcified tendinopathy.

Reconstruction of a Chronic Patellar Tendon Rupture: A Case Report

Reconstruction of a Chronic Patellar Tendon Rupture: A Case Report

Treatment of chronic ruptures and defects of the Achilles tendon

Achilles tendon ruptures that are older than 4-6weeks or developed over amore extended period are chronic. Two challenges characterize the treatment. First, defect zones over alength of several centimeters must frequently be bridged. Second, aprolonged loss of function of the muscles leads to an irreversible fatty degeneration of the tissue. So that even if the tendon is restored, significant functional deficits remain. If there are doubts about the ability of the calf muscles to regenerate, regardless of the size of the defect, tendon transfers are recommended to use the power of an additional muscle to support the plantar flexion of the ankle. Established concepts are the transposition of the flexor hallucis longus or the peroneus brevis muscle. If the muscle is intact, defects of up to 2 cm can be treated with adirect suture. Defects between 2and 5 cm can be bridged using aVY-plasty or aturndown flap. For larger defects, free tendon transplants can be considered. The technical alternative for larger defects is atendon transfer of the flexor hallucis longus or the peroneus brevis muscle. Besides bridging the defect, another advantage of tendon transfer is that vital muscle tissue is placed in the bed of the Achilles tendon. Both tendons are covered with muscle tissue over nearly the full length, which offers advantages, especially in patients with critical soft tissue or after infection. Follow-up treatment is analogous to an acute Achilles tendon rupture. However, permanent impairments are possible; 75-80% of athletes regain their original performance level.

Clinical and biomechanical comparison of suture-external button versus interference screw associated with V-Y advancement or turndown flaps for flexor hallucis longus transfer in chronic Achilles tendon rupture.

Surgical treatment of chronic Achilles tendon rupture is a technically challenging procedure. We aimed to compare the clinical outcomes, range of motion, and strength of ankle plantar- and dorsiflexors between two techniques for fixation of flexor hallucis longus tendon to the calcaneus: interference screw and suture-external button. Twenty-five patients participated in this retrospective comparative study. All patients underwent short harvest FHL tendon transfer for chronic AT rupture were asked for a follow-up visit, at least one year following surgery. The outcomes were evaluated by visual analog scale (VAS), AOFAS ankle-hindfoot score, and VISA-A questionnaire. Ankle ROM with possible restriction in addition to isokinetic strength of ankle plantar- and dorsiflexors was assessed. No statistically significant difference was observed between the groups for pain (P = 0.81), AOFAS ankle-hindfoot scale (P = 0.97), and VISA-A (P = 0.44). Notably, more decrease in ankle dorsiflexion was seen in interference screw group in comparison with suture-external button group (4.4 ± 6.6 vs. 9.5 ± 6.1 degrees, P = 0.06). The difference of active dorsiflexion between operated and non-operated side in interference screw group was statistically significant (P = 0.02). Biotenodesis screw imposed more limb asymmetry in comparison with suture-external button technique. Fixation of transcalcaneal FHL tendon transfer for chronic AT either by interference screw or suture-external button has encouraging postoperative clinical results. Although ROM of the ankle joint reduced in both techniques, interference screw may result in more reduction in dorsiflexion of the ankle.

VY-plasty for chronic quadriceps tendon rupture

Lengthening of the quadriceps tendon for dehiscence in chronic rupture. Chronic rupture of the quadriceps tendon with delayed diagnosis or failure of primary refixation with adehiscence between 1and 5 cm. Dehiscence of more than 5 cm. Reopen the old incision and lengthen it to about 20-25 cm if necessary. Visualize the rupture. Debridement of the tendon and the insertion. Measurement of the dehiscence. Creation of aV-flap and reinforcement with aholding seam. Gradual mobilization of the V‑flap distally and reinforcement with two strong suture cords (braided suture size5). Drilling of three obliquely ascending drill holes through the patella. Transosseous threading of the two reinforcement cords through the three drill holes. Knotting the reinforcement cords on the patella. Closure of the gap between the patella and the superficial tendon leaflet with a#2 braided suture. Closure of the gap between the V‑flap and the quadriceps tendon. Six weeks of partial weight-bearing with 20 kg in astraight orthosis. Mobility: weeks 1-4 E/F 0-0-60, weeks 5 and 6 E/F0-0-90. We were able to follow-up 8patients (mean age: 63.1 ± 4.5years), who underwent this surgery in the manner described. All patients were able to perform an active extension postoperatively. The Lysholm score increased from 46.4 (± 5.4) points preoperatively to 81.6 (± 6.5) points postoperatively. No further rupture was detectable in the ultrasound examination at latest follow-up after an average of 27 (18-36) months.

Reconstruction of Chronic Soft Tissue Mallet Fingers: Outcomes of Step-Plasty vs. Purse-String Suture.

After failed conservative therapy or in the absence of any intervention, a rupture of the digital subcutaneous extensor tendon at the distal interphalangeal (DIP) joint, known as mallet finger, may lead to a chronic extension deficit due to excessive scarring and tendon elongation. Various surgical techniques to restore the extension of the distal phalanx have been proposed, but an optimal approach has not yet been established. To tighten the extensor tendon, a purse-string suture can be applied. Although it has shown efficacy, it can result in significant bulging and scar formation. Using the "abbreviato" technique, the elongated part of the extensor tendon is excised, and the tendon is re-sutured. Also, tenodesis has been described, particularly in pediatric cases. In this retrospective follow-up study, we aimed to investigate if the step-plasty procedure previously described by Baumeister provides comparable, if not superior, functional and aesthetic outcomes compared to existing techniques for patients with chronic mallet finger. In this retrospective study, a consecutive series of 68 patients with chronic mallet fingers was enrolled. Patients were treated surgically using step-plasty of the respective extensor tendon. After skin incision and tenolysis, the elongated extensor tendon was incised in a Z-like fashion and stepwise resected in the transverse portion of the Z. The functional and aesthetic effects of this step-plasty technique were compared with results of 44 patients previously treated using purse-string sutures of the extensor tendon and evaluated using Crawford's and Levante's criteria. In all patients undergoing the step-plasty procedure, the extension deficit was significantly reduced from an average of 42 degrees preoperatively to 11 degrees postoperatively. In contrast, the control group treated by purse-string sutures showed a slightly higher postoperative extension deficit of 15 degrees. According to Levante's criteria, the results of our step-plasty procedure were significantly better than those achieved with purse-string sutures. Our study demonstrated that the treatment of older or chronic subcutaneous extensor tendon ruptures using the step-plasty technique led to a significant reduction in extension deficits. According to Levante's criteria, the postoperative outcome was significantly better in comparison to the purse-string suture technique. Additionally, no skin resection was required to improve the extension capability of the distal finger joint, compared to established surgical procedures.

Reconstruction of the patellar tendon with autologous or allogeneic semitendinosus tendon transplant for chronic rupture

Reconstruction of apatellar tendon defect in the event of achronic rupture. Chronic rupture of the patellar tendon due to delayed diagnosis or failure of primary refixation with adehiscence that does not allow for anatomical refixation without patellar tendon shortening. Infection. Approximately 15 cm long incision from the tibial tuberosity to the patella. Depicting the rupture. Debridement of the tendon and insertion. Suture in the quadriceps tendon and distalization of the patella. If sufficient distalization of the patella is not possible, optionally perform aVY-plasty of the quadriceps tendon. Measuring the dehiscence. Securing the height of the patella by applying apatellotibial cerclage (strong suture cord). Extension of an existing tendon stump using aZ-plasty. Creation of 2bone tunnels (diameter approx. 5 mm) in the patella and the tibial tuberosity. Insertion of an autologous or allogeneic semitendinosus tendon transplant and securing it by knotting the retaining threads in front of the tibial tuberosity. Six weeks of partial weight-bearing with 10 kg of body weight in astraight, removable splint. Range of movement: weeks 1-4 E/F 0-0-60°, weeks 5-6 E/F 0-0-90°. Seven patients who underwent this surgery as described above had aminimum follow-up of 2years. Secondary lengthening of the quadriceps tendon had to be performed twice due to excessive retraction. All patients were able to perform active extension postoperatively. The Lysholm score rose from 49.3 to 83.2 points. No further rupture was detectable in the final ultrasound examination.

Evaluation of Surgical Reconstruction of Old Tendo Achilles Injury by Bosworth Technique

Background: Chronic Achilles tendon rupture in the watershed hypovascular region (zone II) makes end-to-end repair less feasible. Bosworth's technique, involving gastrocnemius-soleus turndown, was studied to determine its efficacy and functional outcome in repairing chronic tendon in zone II. Objective: To evaluate surgical reconstruction of old Tendo Achilles injury by Bosworth technique. Methods: This prospective study was carried out in Dhaka Medical College Hospital (DMCH) form July 2006 to December 2007. 20 cases were selected as non-randomized purposive sampling technique who came to the out patients department of DMCH. All cases were diagnosed as old neglected Tendo Achilles injury and treated by surgical reconstruction by Bosworth technique. Two cases were lost from follow up and discarded from the study. Finally the study was done on 18 patients. Results: The mean age of the patients was 31.7 years and the lowest and highest cases were 17 and 47 years respectively. The male female ratio was 5:1. One-third (33.3%) patients were day labourer, 22.2% service holders, 16.7% house wives and the rest 27.8% students. Two-Third of the patients (67%) had involvement of left Tendo Achilles and the rest (33%) had right Tendo Achilles. Nearly 40% of patients’ injury was caused by the overhanging edge of the toilet Pan, 27.8% by traumatic rupture, 11.1% assaulted by sharp weapon, another 11.1% by sharp edge of a metallic plate, 5.6% accidentally by sharp cutting knife and 5.5% by broken glass. The mediun level of injury was 3.5 cm above from the insertion of Tendo Achilles, while the lowest and highest level were 2.5 and 6 cm. Minimum delay from injury to operation was 6 weeks and maximum 32 weeks. 5 patients (27.8%) gained normal range of ankle movement, 6 patients (33.3%) decreased by 5° of unaffected side, 4 (22.2%) by 10° and 3 (16.7%) by more than 10⁰. Mean power of planter flexion, mean calf width and mean score to stand on tip toe on injured side relative ........

Treatment outcome of chronic patellar tendon rupture using autogenous semitendinosus graft: a retrospective case series.

This study highlights the pattern of presentation, treatment, early functional outcome, and complications observed in the management of chronic patellar tendon ruptures using our preferred technique of autogenous semitendinosus graft reconstruction. This was a retrospective case series involving consecutive patients who underwent patellar tendon reconstruction and met the inclusion criteria. The outcome measures were determined by thepost-operative knee range of motion (R.O.M), thepost-operative International Knee Documentation Committee (IKDC) score, and pattern of post-operative complications. Nine patients were included in this case series. The mean age of the patients was 35.4 ± 6.8years (range 27-44years). Trauma to the knee accounted for majority of the cases (62.5%). Six (66.7%) of the nine patients suffered a patellar tendon rupture from contact injury during sporting activities. The mean length of time from injury to presentation was 20.5 ± 11.2weeks (range 6-69.5weeks). Normal knee function in a case (11.1%), nearly normal knee function in 7 cases (77.8%), and abnormal knee function in a case (11.1%) were recorded as a measure of outcome of surgery. The mean post-operative IKDC score was 70.0 ± 6.1 (range 55-77), which was higher than the mean pre-operative score of 26.4 ± 5.1 (range 18-32). The post-operative knee R.O.M averaged 97.2 ± 16.2° (range 70-120°) with a single case with a 10° extension lag noted. Normal to near-normal knee function was obtained with the treatment of chronic patellar tendon rupture in the majority of cases using autogenous semitendinosus graft for patellar tendon reconstruction in our series.

Fascia lata autograft for chronic Pectoralis Major ruptures - A technical note

Rupture of the pectoralis major tendon is an uncommon injury but increasing in incidence. Surgical management is often needed, and ruptures treated acutely show more favorable results. However, a significant number of ruptures are missed and diagnosed later in a chronic state. Direct suture without tension is a major challenge in these cases, and interposition grafts are required.Several techniques have been described however none uses a fascia lata autograft.This technical note aims to describe fascia lata autograft as a valid option to treat retracted chronic pectoralis major ruptures. Level of evidenceIV; Study Design: Technical Note.

Technique of Distal Tendon Excision for the Treatment of Chronic Pain Caused by Isolated Proximal Gracilis Tears

Proximal gracilis tear is a rare sports-related injury that can easily lead to misdiagnosis and underdiagnosis. Clinical manifestations are dominated by localized pain, tenderness, and dysfunction. Here, we report a therapy of proximal segmental tear of the gracilis and demonstrate its treatment process and clinical outcome. This Technical Note describes in detail the minimally invasive distal gracilis resection technique for the treatment of chronic proximal gracilis ruptures, focusing on the most important technical aspects and thus attempting to introduce this procedure and make it more widely used in the treatment of similar muscle injuries.

Evaluation of the effectiveness of V-Y plasty of frozen Achilles tendon rupture, with immediate follow-up weight-bearing and rehabilitation. Case analysis

The Achilles tendon is a strong tendon in the human body but is prone to rupture, especially during recreational activities. Misdiagnosis of ruptures can lead to chronic issues, affecting the quality of life. Surgical V-Y plasty is a technique used to treat chronic Achilles tendon ruptures by lengthening the tendon and restoring its continuity. Two cases of Achilles tendon ruptures were presented, where V-Y plasty was performed along with immediate weight-bearing and rehabilitation. The patients showed significant improvement post-surgery, with no symptoms or restrictions on physical activity after about 6 months. The rehabilitation protocol included functional training, regenerative treatments, and follow-up visits to monitor progress. Studies have shown that surgical treatment is more effective in preventing re-tears compared to conservative treatment for Achilles tendon ruptures. V-Y plasty has been proven to be an effective technique for treating chronic ruptures with large defects in tendon continuity. Immediate weight-bearing and rehabilitation post-surgery have shown positive outcomes in patient recovery. Further research is needed to establish a standardized rehabilitation protocol for Achilles tendon ruptures. The unique management regimen used in the cases presented yielded successful results, emphasizing the importance of immediate rehabilitation post-surgery for improved patient outcomes. V-Y plasty with immediate weight-bearing and rehabilitation is a promising method for treating chronic Achilles tendon ruptures.

The current status and challenges of surgical treatment for chronic Achilles tendon rupture

With the growing demand for physical activity, an increasing number of individuals with chronic Achilles tendon ruptures are opting for surgical intervention. Surgical approaches encompass end-to end anastomosis, tendon flap techniques, tendon transfer procedures, and free tendon grafting, among others. When selecting the appropriate surgical method and determining the surgical indications, it is imperative to consider factors like the length of the Achilles tendon defect, patient age, aesthetic preferences, functional requirements, and local tissue conditions. As medical devices evolve and surgical techniques advance, the criteria for surgical intervention are also evolving. Drawing from existing literature evidence, it becomes crucial to define reasonable parameters for addressing Achilles tendon defects with each surgical technique, aligning more closely with clinical needs. Additionally, auxiliary technologies such as biologic therapy and innovative biomaterials have demonstrated promising results in laboratory or animal models. The focal point of advancing these auxiliary technologies lies in facilitating the translation of pertinent clinical outcomes in the future.

A Comparative Analysis of Outcomes using PROMIS after Operative vs Non-operative Treatment of Achilles Rupture

Introduction/Purpose: Achilles tendon rupture is a common injury in the adult population. The role of operative and non- operative management remains controversial with the development of functional rehabilitation programs. The purpose of this study is to evaluate and compare the patient-reported outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) after operative and non-operative treatment of acute Achilles rupture. PROMIS is a valid, reliable, and effective tool to evaluate patient outcomes after treatment for Achilles ruptures. Our hypothesis is that there is no significant difference in PROMIS scores between patients undergoing operative compared to non-operative treatment of Achilles rupture. Methods: Under an IRB-approved protocol, Achilles rupture was identified using ICD 9 and ICD10 codes of 727.67 and S86.0. Patients who underwent Achilles tendon primary repair were identified using CPT code 27650 (Repair, primary open or percutaneous, ruptured Achilles tendon). Revision Achilles repair and chronic Achilles ruptures were excluded. All patients treated non-operative underwent a strict functional rehabilitation protocol. We included patients treated between 1/1/2015 and 11/30/2022. PROMIS physical function (PF), pain interference (PI), and depression scores were routinely collected prospectively during the initial office visit and follow-up appointments. A distribution-based method used to determine the minimal clinically important difference (MCID), which was 1/2 standard deviation of each PROMIS domain. A medical records review was performed to collect patient demographic data. Statistical analysis was used to compare preoperative and postoperative scores and significance was indicated when P< 0.05. Results: 216 patients with Achilles tendon ruptured were included (115 Nonoperative versus 101 Operative). Patients treated non-operatively were older than those treated surgically (mean age: 45.1 vs 35.6; p< 0.001). The operative group had a lower BMI compared to non-operative group (27.8 vs. 29.5; p=0.004). There is no statistical difference in the Achilles tendon re-rupture rate between both groups (operative: 2% vs. 4.3%; p=0.344). Both groups are effective in improving PROMIS PF, PI, and depression scores (p < 0.001). The mean PROMIS PF change (pre- to post-treatment) is significantly greater in the operative, compared to the non-operative group (13.2 vs. 9.5; p=0.042). Both treatments had similar mean PROMIS PI change, mean PROMIS depression change, and rates of meeting MCID for all 3 PROMIS domains at 6 months. Conclusion: In patients with Achilles tendon rupture, operative management may lead to statistically significant higher improvements in physical function compared to non-operative management. However, non-operative management was associated with similar overall rates of re-rupture, PROMIS PI and depression outcomes, and chances of meeting MCID as those who underwent operative intervention. Nonoperative management of Achilles tendon rupture, similar to operative treatment, is a successful treatment option and leads to significant improvement in physical function, pain interference, and depression PROMIS scores.

Salvage Reconstruction of a 12-cm Tendon Defect Following Chronic Achilles Rerupture-15-Year Follow-Up: A Case Report.

A 39-year-old man with a chronic Achilles rupture status post (1) failed primary repair and (2) secondary xenograft repair with graft rejection, resulting in a 12-cm Achilles tendon defect, which was reconstructed utilizing an Achilles bone block allograft and flexor hallucis longus (FHL) tendon transfer. At 15-year follow-up, the patient reported good functionality and satisfaction with the repair, with positive patient-reported outcome measures. Physical examination revealed excellent strength and range of motion. Magnetic resonance imaging confirmed the integrity and incorporation of the Achilles/FHL graft composite. This case study provides valuable insight into successful long-term management of complex chronic Achilles ruptures with large defects.

Visceral Aorta Electrocautery Septotomy to Allow Branched Endovascular Aortic Repair in Ruptured Chronic Post-Dissection Thoraco-Abdominal Aneurysm.

Endovascular repair of chronic post-dissection thoraco-abdominal aortic aneurysms (PD-TAAA) presents specific technical challenges due to the presence of chronic septum. Small true lumen diameter and false lumen visceral vessel origin can make branched endograft prohibitive. Septotomy may allow to overcome these challenges in cases of high complex anatomy. We describe the application of electrocautery septotomy to the visceral aorta segment to deploy an off-the-shelf branched endograft in a chronic PD-TAAA rupture with true lumen collapse. Electrocautery septotomy can be an effective adjunctive technique to facilitate branched endograft, overcoming technical challenges associated with the endovascular treatment of chronic PD-TAAA. Electrocautery septotomy is an adjunctive technique that can facilitate endovascular treatment of post-dissection thoraco-abdominal aneurysm. By creating a common lumen, this technique might reduce the number of re-interventions associated with PD-TAAA endovascular exclusion.