Cadaver bone-tendon graft for xanthomatosis of the tendo Achillis

Abstract

We describe a 63-year-old man who had xanthomatosis of the right tendo Achillis. He had undergone excision of the left tendo Achillis 17 years earlier without reconstruction for the same condition. The neurological history and examination were normal. Blood investigations showed hypercholestrolaemia, for which he was being treated with statins. He was referred with pain in the right tendo Achillis and problems with footwear. He was treated by excision of the right tendo Achillis, the xanthomatous nodules and the involved skin, followed by reconstruction with a cadaver bone-tendon graft. At follow-up eight months postoperatively, the scar had healed well. He walked without pain and could wear any type of shoe. Plain radiographs showed that the bone graft had healed. The American Orthopaedic Foot and Ankle Society hindfoot score was 95/100. The patient's subjective evaluation of the result was very good.

Reconstruction of the Achilles tendon using quadriceps tendon graft in bilateral xanthomas secondary to familial hypercholesterolemia: A case report

“…[11][12][13] The use of local tendons such as peroneus brevis (PB) and FHL have also been proposed. [14,15] Boopalan et al [13] recommended the use of free autologous tendon grafts from the gracilis, semitendinosus or tensor fasciae latae (TFL) muscles. Allografts have also been used in reconstruction.…”

Reconstruction of bilateral tendoachilles with fascia lata graft

“…Other available therapy option for reconstruction are V-Y tendon alignment with plantaris weaving, gastrocnemius free turndown flaps, fascia lata, flexor digitorum longus transfer and bone tendon bone autograft harvested from the knee extensor mechanism. The use of cadaveric tendoachillis allograft has also been advocated,[810] but it was not possible in our case as tissue banking facilities were not available at our center. In our case, reconstruction following resection of both tendoachilles was difficult as following removal there was large defect in the Achilles tendon, which was too extensive to be reconstructed satisfactorily by any of the available methods.…”

“…The majority of reconstructive procedure involve autogeneous tissue transfers or heterogeneous homologous grafts. [8910] However, the latter was not commonly used because of limited suitable donor material availability and higher rates of immunological rejection and infection. [7] Among autogeneous tendon transfer, peroneus brevis and flexor hallucis longus transfer are commonly used, although tibialis posterior is also been used for reconstruction.…”

“…[7] Tendoachillis xanthomas can cause pain, swelling, loss of function and problems with footwear. [8] Several procedures have been described for the reconstruction of chronic degeneration of Achillis tendon. The majority of reconstructive procedure involves autogeneous tissue transfers or heterogeneous homologous grafts.…”

“…The majority of reconstructive procedure involves autogeneous tissue transfers or heterogeneous homologous grafts. [8910] We report a rare case of bilateral xanthomatosis of tendoachilles tendon sheath which was managed by wide surgical excision and reconstruction with tensor fascia lata.…”