Neglected Achilles Tendon Research Articles

Reconstruction for Missed or Neglected Achilles Tendon Rupture with V-Y Lengthening and Flexor Hallucis Longus Tendon Transfer through One Incision

The purpose of this study was to introduce a novel operative technique and to evaluate the clinical outcomes in a cohort of patients with missed or neglected Achilles tendon ruptures. Fifteen consecutive patients with missed complete Achilles tendon ruptures and 5-cm or larger gaps had reconstruction with V-Y lengthening and flexor hallucis longus tendon transfer through a single incision. The patients were evaluated at an average of 106 weeks after surgery. At the time of followup, all patients were assessed with regard to their self-reported level of satisfaction and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Ankle strength and active range of motion were evaluated using Biodex (Biodex Medical Systems, Shirley, NY) isokinetic dynamometry. In addition, seven patients were evaluated using diagnostic ultrasound. We found a 7.7 N-m (-22.3%) loss of plantarflexion torque at 60 degrees/sec and a 3.5 N-m (-13.5%) loss of plantarflexion torque at 120 degrees/sec, as well as a 5 degrees loss of active range of motion. AOFAS scores were all good to excellent, with an average score of 94.1 of 100. All patients were satisfied with their outcomes (rated good or very good). Excellent exposure of the Achilles tendon repair was obtained with ultrasound. For patients with missed or neglected Achilles tendon rupture with a rupture gap of at least 5 cm, operative repair using V-Y lengthening and flexor hallucis longus tendon transfer through a single incision technique achieved a high percentage of satisfactory results.

Achilles Tendon Repair with Acellular Tissue Graft Augmentation in Neglected Ruptures

Neglected Achilles tendon rupture injuries present surgical challenges because of the quality and quantity of tendon tissue during repair combined with the magnitude of mechanical forces placed on this tendon. The purpose of this study was to evaluate the effects of an acellular human dermal tissue matrix, GRAFTJACKET, as an augmentation material in neglected Achilles tendon repair. Nine patients with neglected Achilles tendon ruptures were evaluated and followed up for a minimum of 20 months. Primary repair was followed by augmentation with the graft and suturing circumferentially around the tendon. Patients were placed in an early, functional rehabilitation program with postoperative evaluation at 3, 6, and 12 months. Outcome scores were calculated based on the American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring system. At 20 to 30 months postoperative follow-up range, there has been no incidence of re-rupture or recurrent pain. The average return-to-activity time was 15.2 +/- 1.7 weeks. The results from this retrospective clinical series suggest that using an acellular human dermal tissue matrix to augment neglected Achilles tendon rupture primary repair offers desirable return-to-activity time points and viable surgical alternative over previously reported surgical options.

A Combined Repair Technique for Early Neglected Achilles Tendon Ruptures.

This study presents the long-term results of a combined technique, using both Duthie's biological repair and a plantaris tendon transfer for the reconstruction of early neglected tendo Achilles ruptures. Between January 2000 and November 2004, nine patients with an early neglected Achilles tendon rupture (≥ 4 and ≤ 12 weeks from injury), underwent surgical reconstruction. Eight patients were male and one female, their age was average 41 years and the median follow-up period was 3.66 years. The average clinical defect of the Achilles tendon was 4.33 cm. All patients were examined by the clinical ankle scoring system of Leppilahti et al. (Clin Orthop 346:152-161, 1998). Six patients presented excellent results and three patients had good results. All patients had equal plantarflexion and dorsiflexion with the healthy side and all of the study's patients returned to work 3 months postoperatively. An average muscle atrophy of 0.83 cm was documented compared with the uninjured side. Only four of nine patients (44.44%) had a normal one-legged jump. There were no complications postoperatively and no re-ruptures of the Achilles tendons. This combined method appears to be safe and effective, with a low risk for complications, allowing us to obtain excellent results for the majority of our patients.

Technique Tip: Avoiding Wound Complications After Neglected Achilles Tendon Repair Using a Tissue Expansion Technique

Technique Tip: Avoiding Wound Complications After Neglected Achilles Tendon Repair Using a Tissue Expansion Technique

Reconstruction of a Neglected Achilles Tendon Rupture With an Achilles Tendon Allograft: A Case Report

Multiple surgical techniques for repair of neglected Achilles tendon ruptures have been described in the literature. The authors present a case using a freeze-dried Achilles tendon allograft for repair of a neglected rupture of the Achilles tendon with a defect of 10 cm. At 1-year follow-up, the patient achieved pre-injury functional use of the affected limb.

Free Gracilis Tendon Graft in Neglected Tears of the Achilles Tendon

To report the results of a longitudinal study on reconstruction of neglected Achilles tendon rupture using a free autologous gracilis tendon graft. Cohort study. Twenty-one patients underwent surgery for a neglected rupture of the Achilles tendon occurring between 65 days and 9 months before the operation. All participants were prospectively followed up for 2 years, and final review was performed at 28.4 +/- 3.5 months from the operation. Functional (anthropometric measurements, isometric strength, return to activities) and clinical assessment was performed. No patients experienced any problems in the wound used to harvest the tendon of gracilis. Five patients were managed conservatively following a superficial infection of the Achilles tendon surgical wound. No patients developed a deep vein thrombosis or sustained a rerupture. All patients were able to walk on tiptoes, and no patient used a heel lift or walked with a visible limp. The maximum calf circumference remained significantly decreased in the operated leg at final review. The operated limb was significantly less strong than the nonoperated one. The management of neglected tears of the Achilles tendon by free gracilis tendon grafting is safe but technically demanding. It affords good recovery, even in patients with a neglected rupture of a duration of 9 months. These patients should be warned that they are at risk for postoperative complications, and that their ankle plantar flexion strength can remain reduced.

Reconstructing and resurfacing open neglected Achilles tendon injury by distal posterior tibial artery perforator based adipofascial flap

Surgical management of open neglected Achilles tendon injury and damaged overlying skin is very demanding. Here, we report a case of 50 year-old man who sustained an injury to the left Achilles tendon causing complete disruption of the tendon with an open wound. The patient came to us after 3 months and was managed by tendon debridement, reconstruction by the Bosworth method, and resurfacing with a distal posterior tibial artery perforator based turn-over adipofascial flap covered with a split thickness skin graft. There was minimal skin graft loss which healed by itself. A 9 month follow up of the reconstructed tendon showed a good functional result and a normal range of dorsi and plantar flexion of the foot. This technique provides an easy and quick solution to resurface the tendoachilles with minimal donor site morbidity.

A case of neglected Achilles tendon rupture for 28 years

A case of neglected Achilles tendon rupture for 28 years

Repair of neglected Achilles tendon rupture using gastrocnemius fascial flaps.

Neglected Achilles tendon rupture is a rare disorder. In this article, we discuss the results of 10 patients with neglected Achilles tendon ruptures who were treated surgically. Between 1980 and 1997, we treated 10 patients (6 men and 4 women) using gastrocnemius fascial flaps according to the method described by Lindholm. The mean age of the patients at the time of the operation was 51 years (range 38-57 years). They were followed-up for 26-192 months. There were significant differences between the American Orthopaedic Foot and Ankle Society (AOFAS) scale score before the operation (72.6+/-5.3) and the score at the most recent follow-up (98.1+/-2.5) (p<0.0001). On Cybex isokinetic strength testing, the peak torque deficiencies in plantar flexion ranged from 8% to 68% at the low setting and from 19% to 33% at the high setting preoperatively, and ranged from -9% to 17% at the low setting and from -13% to 23% at the high setting postoperatively. There were no re-ruptures. Our data indicate that the reconstructive technique using gastrocnemius fascial flaps can result in an excellent clinical and functional outcome.

Treatment of neglected achilles tendon rupture

Treatment of neglected achilles tendon rupture

Reconstruction of neglected Achilles tendon rupture with Leeds-Keio artificial ligament

Many surgical methods for the treatment of neglected Achilles tendon rupture have been reported. 1–5 Some need long incisions and the sacrifice of other tissues. A wide incision may lead to skin infection and dehiscence. Further, it is very hard to reconstruct the excessive defect, as shortening of the tendon makes the operation more difficult. On the other hand, methods using artificial implants have the possibility of material deterioration. However, polyester fibre can easily induce fibrous tissue and is preserved for a long time in vivo. For the reconstruction, the Leeds-Keio artificial ligament was used which is made of polyester fibre, not only as a scaffold but also as a supporter against the tension of the calf muscles.

Repair of neglected Achilles tendon ruptures: procedures and functional results.

Surgical repair of neglected Achilles tendon ruptures presents the challenge of restoring the function of the Achilles tendon complex while repairing the large defect that is created by the delay in appropriate treatment. We present our preferred technique for delayed repair and the results of six patients who were available for complete follow-up evaluation. The combined surgical technique includes: V-to-Y gastrocnemius recession or advancement, excision of the fibroadipose defect, end-to-end anastomosis, gastrocnemius aponeurotic flap to reinforce the anastomosis. Each of six patients were interviewed and examined clinically and by Cybex II isokinetic strength testing. All six patients have been able to return to their pre-injury activities. Cybex II isokinetic strength testing demonstrated peak torque deficiencies in plantar flexion ranging from 2.5%-22% as compared with the unaffected limb. The overall results of the technique described indicate that very satisfactory functioning of a neglected Achilles tendon rupture can be obtained.

Repair of neglected Achilles tendon ruptures: procedures and functional results

Repair of neglected Achilles tendon ruptures: procedures and functional results

Repair of neglected achilles tendon ruptures with Marlex mesh

Various surgical techniques have been described for the management of neglected ruptures of the Achilles tendon. They mainly include the use of surrounding autogenous tissues such as the tendon of plantaris, peroneus brevis, strips of fascia lata or triceps surae aponeurosis. The application of these techniques is not always possible in elderly patients or patients with rheumatoid arthritis, as their tissues are often too weak to be used for reconstruction. In such cases, the use of a synthetic material may be preferable. This paper reports our experience of five cases where the tendo Achillis (TA) was reconstructed with Marlex (polypropylene) mesh, producing satisfactory results.

Repair of neglected achilles tendon ruptures with a triceps surae muscle tendon advancement

Neglected Achilles tendon ruptures, although rare, can be a surgical challenge for the lower extremity specialist. These injuries often present with large defects which require special reconstructive techniques and principles. This paper presents an overview of this problem, various treatment strategies, and two case reports utilizing a triceps surae muscle tendon flap advancement.

Reconstruction of Neglected Achilles Tendon Injury

Chronic Achilles tendon injuries are debilitating injuries that are often difficult to treat. A review of previously reported procedures is presented. A new technique for repair is presented utilizing a transfer of the flexor hallicus longus muscle and tendon to provide a dynamic repair. A review of the clinical outcome from this procedure is provided.

Tissue expansion in late repair of tendo Achillis rupture

The Journal of Bone and Joint Surgery. British volumeVol. 77-B, No. 1 ArticlesFree AccessTissue expansion in late repair of tendo Achillis ruptureA Mohammed, A Rahamatalla, CH Wynne-JonesA MohammedSearch for more papers by this author, A RahamatallaSearch for more papers by this author, CH Wynne-JonesSearch for more papers by this authorPublished Online:1 Jan 1995https://doi.org/10.1302/0301-620X.77B1.7822399AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByRupture of a Breast Tissue Expander Due to Chest Wall Exostosis: Case Report and Literature Review1 December 2015 | Plastic Surgery Case Studies, Vol. 1, No. 3Complex Achilles Reconstruction for Massive Soft Tissue Loss: Allograft, Autograft, and Use of a Temporary Cement SpacerJournal of Orthopaedic Trauma, Vol. 24, No. 8Surgical Strategies: Delayed Diagnosis or Neglected Achilles’ Tendon Ruptures1 April 2008 | Foot & Ankle International, Vol. 29, No. 4A Combined Repair Technique for Early Neglected Achilles Tendon Ruptures16 October 2007 | European Journal of Trauma and Emergency Surgery, Vol. 34, No. 1Quantitative Review of Operative and Nonoperative Management of Achilles Tendon Ruptures30 August 2017 | The American Journal of Sports Medicine, Vol. 30, No. 4A reversed Z-plasty skin incision for Achilles tendon reconstructionFoot and Ankle Surgery, Vol. 8, No. 4Soft tissue expansion prior to arthroplasty in the multiply-operated kneeThe Journal of Arthroplasty, Vol. 11, No. 5 Vol. 77-B, No. 1 Metrics Downloaded 96 times History Published online 1 January 1995 Published in print 1 January 1995 InformationCopyright © 1995, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Reconstruction of Neglected Achilles Tendon Rupture With Marlex Mesh

Reconstruction of the neglected Achilles tendon rupture was performed with marlex mesh on six patients. Marlex mesh was folded into three layers and sandwiched between both ruptured ends that were divided horizontally into two layers in moderate tension. All of the patients showed satisfactory function with a mean follow-up period of 3 years (range, 2.4-3.7 years). The operative procedure is simple because there is no need to harvest healthy tendon or fascia as the donor and there is less adhesion with neighboring tissues and minimal signs of foreign-body reactions.

A Method of Repair for Achilles Tendon Ruptures Without Cast Immobilization

A new technique for the repair of Achilles tendon ruptures has been developed with a Dacron vascular graft used as a tension suture material. The suture is passed through the calcaneal tuberosity and, with two loops applying tension to the tendon at the level of the musculotendinous junction, brings the tendon ends together by creating a solid structure. Post-operative immobilization and its possible adverse sequelae are eliminated by this procedure. The technique was first tested on five dogs with severed Achilles tendons of both hind legs. One side in each animal was repaired with this suture technique; the second leg was left as an untreated control. All the animals recovered from surgery and walked almost normally on the sutured leg within less than three weeks. The dogs did not walk on the unsutured legs. In a second procedure, the control leg was repaired by the same reparative procedure. Equally good results were obtained. The technique was then used on five patients with recent and neglected Achilles tendon ruptures or lacerations. In all instances excellent surgical results were obtained and leg immobilization was virtually eliminated. Physical therapy was begun in the immediate postoperative period. The rehabilitation period was significantly reduced.