Neglected Achilles Tendon Rupture Research Articles

Modified gastro-soleus turn-down flap for chronic or neglected achilles tendon ruptures

BackgroundAchilles’ tendon chronic rupture is a common entity that is usually misdiagnosed or mistreated. Hence, she was presented to us later or with complications affecting her gait. Surgical resection is needed to either bridge the gap or reinforce the strength of the tendon repair.ObjectivesOur study's goal was to assess the clinical results of repairing chronic Achilles’ tendon lesions employing the middle segment of the proximal portion of the tendon (gastro-soleus), as a turn-down flap.MethodsOur prospective interventional single arm study included 18 patients with chronic Achilles’ tendon rupture attending at Al-Azhar university hospitals in Cairo, Egypt from May 2020 to April 2023. Diagnosis of the patients was confirmed by radiographic and clinical investigations. They were all treated with the same open reconstruction procedure using a modified GSF. The average follow-up was 12 months. The results of this study were assessed by the Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) score, and capacity to perform repeated heel raises on the affected side.ResultsThe mean operative time was 72.77 min. The median (IQR) time of reconstruction was 10 (8–12) after the injury. The median (IQR) length of flab was 4.5 (4.3–5) 9 (Table 2). No intraoperative complications occurred. The typical follow-up period was 12 months (6–18 months). In terms of the ATRS, we found a significant reduction from 82.8 ± 3 preoperatively to 20.8 ± 6.7 at 12 months postoperatively (P value = 0.001). As regards the AOFAS score, it was increased from 49.5 ± 10 preoperatively to 83.8 ± 8.5 12 months postoperatively (P = 0.001). In terms of the post operative complications, there was no re-rupture. Two patients experienced superficial wound infection which improved with daily dressing and antibiotics. Additionally, two patients had slight ankle stiffness four months after the operation, which improved after programmed rehabilitation at the sixth month.ConclusionThe modified GSTF is a simple, safe, well-tolerated and effective method of treatment with excellent functional results and greater patient content.

Incidents of Complications after Reconstruction of Neglected Achilles Tendon Injury by Baker's Procedure

Introduction: Neglected Achilles tendon ruptures present a significant challenge in orthopedic surgery, with varied outcomes and complications. This study aims to evaluate the effectiveness of Baker's Procedure in the reconstruction of neglected Achilles tendon ruptures and to analyze the associated postoperative outcomes and complications. Methods: This prospective interventional study was conducted from January 1, 2012, to May 31, 2013, at multiple centers in Dhaka, Bangladesh. It included 42 patients aged 18 to 60 years with neglected Tendo-Achilles ruptures, defined as injuries untreated for over 4 weeks. Baker's Procedure, involving gastrocnemius aponeurosis advancement, was employed for reconstruction. Result: Of the 42 participants, 71.43% were male, with a mean age of 30.7 years. Injuries predominantly occurred in the right Achilles tendon (57.14%) and were mainly caused by sharp-metal objects (57.14%) and toilet-pan accidents (35.71%). Postoperative complications included stitch or wound infections (21.43%), pain (14.29%), stiffness (28.57%), and calf-muscle weakness (35.71%). Excellent, good, and fair outcomes were achieved in 64.29%, 21.43%, and 14.29% of patients, respectively. Conclusion: Baker’s Procedure is effective in reconstructing neglected Achilles tendon ruptures, with a majority of patients achieving excellent or good outcomes. However, the relatively high rate of postoperative complications, particularly infections, calf muscle weakness and stiffness, highlights the need for improved surgical and postoperative strategies. These findings underscore the importance of tailored.

Acute Achilles Tendon Ruptures Treated With Endoscopic Flexor Hallucis Longus Transfer

The Achilles tendon represents the most commonly ruptured tendon of the human body. Numerous studies have evaluated, throughout the years, management options regarding acute Achilles tendon rupture. Minimally invasive techniques have recently gained more popularity. Endoscopic flexor hallucis longus tendon transfer has been mainly described as a treatment method for neglected Achilles tendon ruptures. However, it has recently been described as an applicable treatment option for acute Achilles tendon ruptures as well. Nevertheless, this procedure is technically quite demanding and should be performed by experienced surgeons. This technical note thoroughly describes the endoscopic flexor hallucis longus transfer technique for acute Achilles tendon ruptures, focusing on the most important technical aspects, thus attempting to simplify and render this procedure more widely accepted.

Early satisfactory results of percutaneous repair in neglected achilles tendon rupture

PurposeThis investigation aimed to study the outcome of percutaneous repair of Achilles tendon ruptures regarding patient-reported and objective outcomes.MethodsThis is a retrospective review of a cohort of patients (n = 24) who underwent percutaneous repair of neglected Achilles rupture in the period between 2013 and 2019. Included patients were adults with closed injuries, presented 4–10 weeks after rupture, with intact deep sensation. All underwent clinical examination, X-rays to exclude bony injury and MRI for diagnosis confirmation. All underwent percutaneous repair by the same surgeon, using the same technique and rehabilitation protocol. The postoperative assessment was done subjectively using ATRS and AOFAS score and objectively using a percentage of heel rise comparison to the normal side and calf circumference difference.ResultsThe mean follow-up period was 14.85 months ± 3 months. Average AOFAS scores at 6,12 months were 91 and 96, respectively, showing statistically significant improvement from pre-op level (P < 0.001). Percentage of heel rise on the affected side and calf circumference showed statistically significant improvement over the 12 month follow up period (P < 0.001). Superficial infection was reported in two patients (8.3%), and two cases reported transient sural nerve neuritis.ConclusionPercutaneous repair of neglected Achilles rupture using the index technique proved a satisfactory patient-reported and objective measurement at a one-year follow-up. With only minor transient complications.

Calf muscle evaluation during rehabilitation after flexor hallucis longus tendon transfer in neglected achilles tendon rupture: A case report

Introduction: Neglected achilles tendon rupture is generally defined as a rupture with a delay of more than 4 weeks prior to diagnosis or treatment. Difficulties in management make it one of the challenging problems in orthopedic practice. They have a greater tendency to develop complications and slightly poorer functional outcomes than patients with an acute rupture. Method: This case report features a case of 30 years old female with 3 months of neglected achilles tendon rupture after landing in the wrong position while playing badminton. The patient complains of continuous pain and inability to move her ankle downward, making walking difficult. On physical examination and CT imaging, we found achiles tendon rupture with significant gap and calf muscle atrophy. The patient was then managed operatively by debridement and tendon repair with flexor halucis longus tendon transfer. Result: Follow up 3 months post-operative, found a difference in calf muscle circumference in both legs. At the same time, there is still an improvement in active ROM ankle plantarflexion and positive single heel raise test on the affected side. The functional outcome measured by ATRS obtained 80 points, and AOFAS ankle-hindfoot scales with a value of 91 points. Discussion: With several advantages, FHL tendon transfer is the currently used technique for neglected cases of achiles tendon rupture. Despite long immobilization will induce other complications. Good operative techniques and accelerated rehabilitation are still recommended to gain good functional outcomes for the patient.

Return to Sports Activities After Flexor Hallucis Longus Transfer for Neglected Achilles Tendon Rupture

Transfer of the flexor hallucis longus (FHL) is known to be effective in the treatment of neglected Achilles tendon rupture (ATR). However, evidence on the return to sports activity levels and clinical outcomes is not sufficient. The aim of this study was assessing clinical outcomes and level of sports activity after FHL tendon transfer for treatment of neglected ATR. Twenty-eight patients who underwent FHL transfer for neglected ATR were analyzed retrospectively. Sports activity status was assessed using the Tegner Activity Scale (TAS). Clinical outcomes were evaluated using the Achilles tendon total rupture score and the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale. By the post hoc power analyses, the power level of more than 80% was identified. The preinjury median TAS score was 4 point and unchanged at the last follow-up. The mean Achilles tendon Total Rupture Scores and American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale scores at the last follow-up were 81 and 93, respectively. While the median TAS was unchanged, 9/28 patients suffered from lower activity level after the procedure. In conclusion, midterm results of FHL transfer for neglected ATR were shown to be favorable. The median TAS score was maintained. Nonetheless, 32% of patients returned to sports activities with a TAS score 1 point lower than that at preinjury and with less favorable clinical outcomes.

Description of the surgical technique for repairing neglected Achilles tendon ruptures according to Bosworth

Neglected Achilles tendon ruptures are becoming more common. The etiologies are numerous, often complicating acute ruptures of the undiagnosed calcaneal tendon, whether by ignorance of the pathognomonic signs (loss of the physiological equine in prone position and Thomson’s maneuver) or by erroneous diagnosis of partial rupture often induced by an ultrasound. Also, it can be due to an iterative ruptures or ruptures on a pathological tendon. The treatment is always performed by a surgery. However, techniques are numerous and depend on the indications. We describe in this work the surgical technique of repairing neglected Achilles tendon ruptures according to Bosworth, performed in the Department of Traumatology-Orthopedics and Reconstructive Surgery of the Ibn Rochd University Hospital Center in Casablanca, Morocco.

Description of the surgical technique for repairing neglected Achilles tendon ruptures according to Bosworth

Description of the surgical technique for repairing neglected Achilles tendon ruptures according to Bosworth

Flexor hallucis longus augmentation for Achilles tendon – is pre-operative evaluation of flexor hallucis longus by MRI required?

Objectives: Flexor hallucis longus (FHL) tendon transfer is the method of choice in reconstructing chronic neglected Achilles tendon rupture. We performed a retrospective study to assess the incidence and degree of fatty degeneration of FHL. Material and Methods: Two hundred and twenty-five consecutive MR of ankles were reviewed retrospectively and assessed for fatty atrophy based on Goutallier classification. Results: About 42.7% had Grade 1, 8.4% had Grade 2, 3.1% had Grade 3, and 1.8% had Grade 4 fatty atrophy of FHL. Other lesions identified included posterior ankle impingement, tenosynovitis, loose bodies, and giant cell tumors of the tendon sheath. Conclusion: We suggest pre-operative radiological assessment of the FHL to establish that the FHL muscle and tendon are normal and intact and suitable for transfer surgery. We also discuss the spectrum of pathologies affecting FHL.

Neglected Painful Chronic Achilles Tendon Rupture With No Palpable Gap: A Report of 3 Cases

Purpose: The purpose of this study was to bring to the attention of orthopedic surgeon community of our new technique of quadruple hamstrings graft in neglected Achilles tendon rupture. Materials and Methods: In this technique article we present results of treatment of 3 cases with neglected painful chronic Achilles tendon rupture with no palpable gap using our new surgical technique. Our method uses semitendinosus and gracilis tendon as autograft which are passes through 2 bone tunnels in calcaneum and tied over a button. Results: At least after 1 year each patient was satisfied with result of our treatment. Patients were able to stand on their forefoot without pain. There was no infection or other complications. Conclusions: Our results show that new surgical technique may be use in similar cases and should be evaluated with better analytical studies.

Reconstruction of neglected tendo-Achilles tears using the technique of gastrocnemius-soleus turndown graft: A case series

Chronic, neglected Achilles tendon ruptures cause a significant impairment of ankle function due to weakness of active plantar flexion which is required in performing day-to-day activities such as walking and climbing stairs. The causes range from trivial trauma like a slip and fall to high impact injuries. Predisposing factors include a history of previous steroid injections, advanced age, and vigorous sporting activities. Tears involving the zone 2, where vascularity is compromised, pose a challenge to surgeons, as the repair is often jeopardized by wound complications and re-ruptures. Of the several techniques described, we have used the Bosworth's technique of gastrocnemius-soleus turndown to reconstruct defects in this zone in 16 patients and have achieved a satisfactory functional outcome at 1 year with a relatively low incidence of complications. However, this technique requires the presence of an intact distal stump of the tendon of adequate length, the absence of which precludes the use of this method.

Restoration for neglected Achilles tendon rupture using a matured scar tissue in an elder patient; A case report

Restoration for neglected Achilles tendon rupture using a matured scar tissue in an elder patient; A case report

Flexor Hallucis Longus Tendon Single-Incision Transfer Stabilized With Autologous Bone Fixation

Flexor hallucis longus transfer is routinely used as a technique to salvage a chronic or neglected Achilles tendon rupture. The single-incision (or short harvest) technique provides adequate graft suitable for fixation with interference screws. We have used a bore corer instead of a drill to establish the tendon tunnel and at the same time use the harvested autograft for interference fit and avoid the use of screws, providing what we consider to be a more biologic form of fixation.

Endoscopic Flexor Hallucis Longus Tendon Transfer for Reconstruction of the Achilles Tendon Rupture in High-Risk Patients: A Case Series

The neglected Achilles tendon rupture requires surgical reconstruction for the best functional outcome. According to the current literature, there are many reconstructive options available that demonstrate acceptable functional results in most cases. These procedures require large incisions, leading to potential wound-healing complications. Therefore, these procedures may not be suitable for patients who are at high risk for wound-healing problems. A minimally invasive approach is desirable in this situation to decrease the risk of this potential complication. Endoscopic transfer of the flexor hallucis longus tendon is described in this series as an alternative to reconstruct the Achilles tendon in 2 such high-risk individuals. Both patients had a successful outcome with no wound-healing problems and regained acceptable functional status.

Mid-Term Results of Primary Repair and Plantaris Tendon Augmentation Technique in Neglected Achilles Tendon Rupture.

ABSTRACTAim: To assess clinical and functional outcomes of primary repair and plantaris tendon augmentation technique employed in neglected Achilles tendon rupture.Methods: We retrospectively reviewed 20 patients underwent surgical treatment with primary repair and plantaris tendon augmentation technique for neglected Achilles tendon rupture between 2011 and 2014. At the last follow-up, the patients were clinically assessed by American Orthopedic Foot &amp;amp; Ankle Society (AOFAS) hindfoot score, Visual Analogue Scale (VAS) score, calf circumference, single-limb heel rise test and range of motion in ankle. Results: Mean time from rupture to surgery was 7.8 weeks (range 4-16 weeks). The mean gap was 44 mm (range 30-75 mm). Mean postoperative follow-up period was 62 months (range 56-84 months). At the last follow-up, mean AOFAS score was 93.6 (range 82-100) while VAS score was found as zero in all patients. No significant difference was detected in mean calf circumference and plantar flexion and dorsiflexion range of ankle between involved site and contralateral intact site (p=0.40; p=0.59 and p=0.68, respectively). One patient suffered from superficial skin infection which was treated successfully with antimicrobial therapy. There were no cases of deep-vein thrombosis, skin necrosis, or re-rupture. Conclusion: In neglected Achilles tendon rupture, primary repair and plantaris augmentation technique is associated with successful clinical and functional outcomes at mid-term.

Reconstruction of neglected Achilles tendon rupture: flexor hallucis longus transfer versus gastrocnemius turn-down flaps

Objective: To compare the outcome of either flexor hallucis longus transfer or turn-down of proximal Achilles tendon tissue repair in treating chronic Achilles tendon rupture. Methods: The clinical data of 21 patients who underwent repair of Myerson type Ⅲ chronic Achilles tendon rupture at Peking University Sports Medicine Research Institute from May 2012 to March 2015 were retrospectively analyzed. Among them, 11 cases were treated with flexor hallucis longus (FHL) transfer, and 10 cases were treated with gastrocnemius turn-down flaps repair. The American Orthopedic Foot & Ankle Society (AOFOS) hindfoot score and Tegner motor function score before and after surgery were recorded and compared between the two groups. Data comparison between groups was performed with t test. Results: The patients in the both group were followed up for an average of (21±7) months. The postoperative AOFOS hindfoot score in the long flexor and gastrocnemius groups were both significantly higher than those before surgery, and the differences were statistically significant (97.7±2.6 vs 72.0±8.1 and 96.0±5.5 vs 78.5±6.4, t=10.70, 6.42, both P<0.05).The postoperative Tegner scores of the two groups were also significantly higher than those before surgery (4.2±1.4 vs 0.7±0.4 and 4.1±0.8 vs 0.6±0.5,t=7.29, 9.35, both P<0.05). There were no significant differences in postoperative AOFOS hindfoot scores and Tegner motor function scores between the two groups (both P>0.05). Conclusion: The flexor hallucis longus transfer and turn-down of proximal Achilles tendon tissue repair can both get satisfactory results in treating chronic Achilles tendon rupture.

OUR APPROACH TO TREATMENT OF NEGLECTED ACHILLES TENDON RUPTURES. IS THERE A SIMPLE SOLUTION?

Introduction. Subcutaneous rupture of achilles tendon is a frequent trauma and most patients with such pathology are men of working age. Even though it is not difficult to diagnose such ruptures, especially those that need surgical treatment, there are numerous cases when patients come to a surgeon with a big delay. In such cases, the rupture becomes «chronic» or «neglected» and can be no longer treated as an acute rupture. There are many techniques of operative treatment of chronic achilles tendon ruptures, but still there is no consensus on which technique is to be considered the most simple, effective and safe.The aim of this study is to evaluate the effectiveness of using peroneus brevis tendon as a graft for treatment of achilles tendon defects type 3 in Kuwada classification. Will this technique bring good and excellent results that are comparable with end-to-end suture after acute achilles tendon ruptures?Materials and methods. The present study includes 13 patients in which peroneus brevis was used for treatment of neglected achilles tendon rupture (group I) and 18 patients after end-to-end suture after acute achilles tendon rupture (group II). Group I consisted of patients with neglected rupture of achilles tendon that was not previously treated due to various reasons and with a significant defect.Results. Mean surgery duration in group I was 91.9±6.6 (Me — 100) min, in group II — 43.2±2.2 (Me — 45) (p = 0.0001). damaged limb was evaluated using achilles Tendon Total Rupture Score, mean post-op follow up was around 1 year. The results were: group I — 86.6±2.28 (Me — 87), group II — 93.4±1.01 (Me — 94) (p = 0.04). This means, that despite quite high scores in group I, they are still statistically worse than scores after suture of acute rupture in group II. There was no difference in post-operative complication rate between the groups (p0.05). The most common complication for both groups was range of motion restriction in ankle joint. None of the patients had ankle joint instability after surgery.Conclusion. Management of neglected ruptures of achilles tendon type 3 (in Kuwada classification) with peroneus brevis autologous graft is an effective and safe technique, that achieves good and excellent results in treatment of this group of patients, in absolute numbers is comparable to functional outcomes after end-to-end suture of acute achilles tendon ruptures, but statistically demonstrates significantly worse results.

Merits and demerits of different surgical techniques in treating old, neglected ruptures of tendo achilles

Study conducted in 25 patients in NRI general hospital. Study included 19 males and 6 female patients. Trauma is most common mode of injury and ruptures were significantly common in patients who received local steroid injection. Most of ruptures are in zone 2. In majority of cases gap in tendon is more than 4cms. Bosworth repair done in 13 cases, FHL transfer in 7 cases and peroneus brevis transfer in 5 cases. Excellent results are seen in 14 cases, good in 7 cases, fair in 3 cases and poor in 1 case. All the procedures had similar good to excellent results in range of 80-85%. Though many surgical treatments are available for reconstruction of a neglected Achilles tendon rupture, there is no concrete data to support that one technique is superior over another.

Minimal Invasive Reconstruction of Neglected Achilles Tendon Rupture

Category: Sports Introduction/Purpose: Recently minimal invasive reconstruction using semitendinosus tendon autograft was shown to be safe and successful for neglected Achilles tendon ruptures. We hypothesized that allograft could also result in similar result like in the reconstruction of anterior cruciate ligament of the knee joint. Methods: Between December 2013 and September 2015, 19 consecutive neglected Achilles tendon rupture cases underwent minimally invasive reconstruction using semitendinosus allograft tendon regardless of rupture time and gap. Out of them, 5 patients had flexor hallucis longus tendon transfer additionally. Thirteen were male, and the average age at the time of surgery was 63(30~82). MRI was checked to confirm the diagnosis in all cases. The Achilles tendon total rupture score(ATRS) was measured for clinical outcome at both pre and post surgery. Thompson squeezing test, knee flexion test, and single-heel-rise test were recorded. Isokinetic strength of plantar flexion by peak torque with plantar flexion at speeds of 30 and 120°/sec was measured to check triceps muscle power after surgery. Results: The mean follow-up period was 13.6(6~26) months. The ATRS was improved from 34(7~72) to 70(48~97) after the surgery(p&lt;0.0001). At the latest visit, all patients showed negative Thompson squeezing test, and in knee flexion test 16 patients showed normal ankle plantar flexion. Thirteen patients could raise their affected heel at the time. In the affected leg at speeds of 30 and 120°/sec, the isokinetic strength was 14.9(6.0~31.9) and 10.0 Nm (2.8~ 19.0) Nm preoperatively, and 37.3(12.1~90) and 19.6(7.8~47) Nm at the latest follow-up. (P=0.012, 0.017) There was no wound problem, rerupture or other complications related to the surgery. Conclusion: Minimally invasive reconstruction using semitendinosus allograft tendon seems to safe and effective for the treatment of neglected Achilles tendon without sacrificing other healthy tissues. We think that this technique can provide a significant improvement of symptoms and function with fewer complications.

Direct Repair of Chronic Achilles Tendon Ruptures Using Scar Tissue Located Between the Tendon Stumps.

Several surgical procedures for chronically ruptured Achilles tendons have been reported. Resection of the interposed scar tissue located between the tendon stumps and reconstruction using normal autologous tissue have been well described. We developed a direct repair procedure that uses scar tissue, which obviates the need to use normal autologous tissue. Thirty consecutive patients with Achilles tendon ruptures with a delay in diagnosis of >4 weeks underwent removal of a section of scar and healing tissue with direct primary suture of the ends of the tendon without the use of allograft or autograft. Patients were followed for a mean time of 33 months. Preoperative and postoperative clinical outcomes were measured with the Achilles Tendon Total Rupture Score (ATRS) and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. In addition, the patients underwent preoperative and postoperative functional measurements and magnetic resonance imaging. Lastly, we evaluated the histology of the interposed healing tissue. The mean AOFAS scores were 82.8 points preoperatively and 98.1 points postoperatively. The mean postoperative ATRS was 92.0 points. At the time of the latest follow-up, none of the patients had experienced tendon reruptures or difficulties in walking or climbing stairs, and all except 2 patients could perform a single-limb heel rise. All athletes had returned to their pre-injury level of sports participation. Preoperative T2-weighted magnetic resonance imaging showed that 22 Achilles tendons were thickened with diffuse intratendinous high-signal alterations, and 8 Achilles tendons were thinned. Postoperative T2-weighted magnetic resonance imaging findings included fusiform-shaped tendon thickening and homogeneous low-signal alterations of the tendons in all patients. Histologically, the interposed scar tissue consisted of dense collagen fibers. Shortening of the tissue between the 2 tendon ends that included healing scar and direct repair of healing tendon without allograft or autograft can be effective for treatment-delayed or neglected Achilles tendon rupture. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.