Augmented Repair of Acute Achilles Tendon Ruptures

Abstract

Twenty-five patients who had an acute Achilles tendon rupture were managed with an augmented repair using the gastrocnemius-soleus fascia. All patients healed their repair and there were no re-ruptures. There was one infection. Augmented repair allowed early functional recovery as evidenced by full ankle motion by four to eight weeks, full unassisted weight bearing by three weeks, cessation of braces by four weeks, and return to work by one to six weeks post-operatively. Augmentation adds a sufficient amount of collagen to allow early range of motion and weight bearing without re-rupture. Disadvantages included a long incision, soft tissue prominence, one infection, and sural nerve injury.

Augmented repair of acute Achilles tendon ruptures using gastrocnemius-soleus fascia

“…Infection is a serious complication that can compromise final outcome [14]. The other feared complication of Achilles tendon rupture, rerupture, may actually be diminished by an augmented reconstruction although we did have one case in our series [22]. Injury to the sural nerve can also be avoided if the skin incision is placed posteromedially and the sural nerve is kept within the lateral skin flap.…”

“…In a prospective randomized study, Cetti et al found better results with early motion after surgery [4]. Zell and Santoro [22] reported on 25 acute Achilles tendon ruptures managed with an augmented repair using the gastrocnemius-soleus fascia and found no reruptures and full ankle motion by 4-8 weeks.…”

“…There were more reruptures in the conservative group, but infection complicated two of the surgically treated patients [12]. However, at the present time, many authors favour operative treatment for acute ruptures of the Achilles tendon [2,9,10,17,19,22].…”

“…Surgical techniques include simple end-to-end suture [1,2,16,17,19] and several procedures for augmented reconstruction. [5,13,22] Augmented reconstruction, initially developed for chronic or neglected ruptures, is now also used for acute ruptures by some authors [22]. Simple end-to-end suture is easier and can be performed through a more limited approach [2,16].…”

Simple end-to-end suture versus augmented repair in acute Achilles tendon ruptures: A retrospective comparison in 98 patients

“…It has been stated that the increase in the amount of collagen obtained by augmentation can strengthen the Achilles tendon and thus permit earlier weight bearing after the rupture (Zell and Santoro 2000). The disadvantages of this technique are deformation of the tendon and a longer incision.…”