Allograft and Autologous Reconstruction Techniques for Neglected Achilles Tendon Rupture: A Mid-Long-Term Follow-Up Analysis

Abstract

Achilles tendon ruptures that are not immediately recognized and treated are sometimes diagnosed as delayed injuries and may require different surgical repair options based on gap size. The potential complications associated with using an allograft for reconstruction may lead some surgeons to prefer the use of autologous techniques. However, allografts are often considered a salvagement option when large defects are present. In this study, we examined the long-term clinical outcomes and complications of 17 patients who underwent surgical repair for chronic ruptures with large gaps using both autologous and allograft techniques. During an 11-year period, nine patients were treated with autologous techniques (mean gap of 4.33 ± 1.32 cm) and Achilles allograft reconstruction was performed in eight patients (47.1%) (mean gap of 7.75 ± 0.89 cm). At a mean of 82 ± 36.61 months of follow-up, all 17 patients (100%) were able to perform a single heel rise and improved AOFAS (American Orthopaedic Foot and Ankle Society) and ATRS (Achilles Tendon Total Rupture Score) scores. No infections, complications, or re-ruptures were recorded at the end of the follow-up. No significant differences were found in the AOFAS and ATRS scales between both techniques. When an extensive defect is present, the reconstruction with an Achilles tendon allograft can be considered a proper treatment option, as it does not show a higher rate of complications than autologous techniques achieving similar functional outcomes.

Salvage Reconstruction of a 12-cm Tendon Defect Following Chronic Achilles Rerupture—15-Year Follow-Up

“…For such defects, Haraguchi et al were some of the first to note success in treating >5-cm defects utilizing calcaneal bone block allografts-similar to the one employed in our approach 5,11 . In a recent series of large segment Achilles defects (>6 cm) treated by bone block allograft, Jimenez-Carrasco et al showed sustained improvement in ATRS and Academy of Foot and Ankle Surgeons scores at nearly 5 years postoperatively, although they note a prolonged need for weightbearing restriction for bone block incorporation 12 . Similarly, Cenfuegos and Song each report success utilization of a bone block allograft to bridge 12-cm Achilles defects-with bone block incorporation at 1 year-and noted their patient was able to return to preinjury activity 1 year after surgery 13,14 .…”

Surgical management of chronic Achilles tendon rupture: evidence-based guidelines

“…However, studies focusing on the surgical management of CATR were reviewed, specifically those with evidence levels A to D. The researchers carefully analyzed the inclusion criteria of the identified studies to observe and determine the surgical indications for CATR. Following the above search strategy, 16 studies were included [33,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70], of which 1 study was grade A [56], 1 study was grade B [57], 6 studies were grade C [33,[58][59][60][61][62], and 8 studies were grade D [63][64][65][66][67][68][69][70]. The most common conditions for which surgical management is indicated were CATR patients exhibiting signs of functional limitation, such as pain or tenderness, inability to execute a single heel raise, or repetitive single-leg heel raise endurance exercises, as well as difficulty in walking and ascending stairs, along with ankle swelling; these symptoms were accompanied by positive results in the call squeeze and knee flexion [71], and their diagnoses were confirmed through MRI or ultrasound examinations (16 studies).…”