Repair of Chronic Rupture of the Achilles Tendon using 2 Intratendinous Flaps from the Proximal Gastrocnemius-Soleus Complex

Abstract

BackgroundChronic rupture of the Achilles tendon is a surgical challenge, owing to the presence of a gap between the retracted ends, which renders direct repair almost impossible.PurposeIn this study, 2 intratendinous distally based flaps fashioned from the proximal gastrocnemius-soleus complex are used to bridge the gap between the retracted edges of the ruptured Achilles tendon. The flaps are placed in the same line of pull of the ruptured tendon, in an effort to make the graft mimic the original biomechanics as much as possible.Study DesignCase series; Level of evidence, 4.MethodsEleven patients (9 male and 2 female) with neglected ruptures of the Achilles tendon with retracted ends were included in this study. Two flaps fashioned from the proximal gastrocnemius-soleus complex were rotated over themselves, passed through the proximal stump, and then securely inserted into a previously prepared bed in the distal stump.ResultsThe patients were followed up for a period of 6 to 9 years. At the final follow-up, all patients were able to return to their preinjury level of activity within a period of 6 to 9 months. The mean preoperative American Orthopedic Foot and Ankle Society score was 42.27, whereas it was 98.91 at the final follow-up, with a range of 88 (in 1 patient) to 100 points (in 10 patients). All 11 patients showed statistically significant improvement according to the Holz rating system.ConclusionThis technique allows for a bridging of the defect present in chronic ruptures of Achilles tendons, with a minimum of complications and a good final outcome.