Clinical outcomes of chronic Achilles tendon rupture treated with flexor hallucis longus grafting and flexor hallucis longus grafting plus additional augmentation: A meta-analysis

Apinun, Jirun; Jenvorapoj, Somjet; Arirachakaran, Alisara; Kongtharvonskul, Jatupon

doi:10.1016/j.fas.2019.09.006

Cited by 19 publications

(11 citation statements)

References 37 publications

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“…Many of them involve local tendon transfer to the injured Achilles tendon, for example the flexor hallucis longus and peroneus brevis [ 27 , 32 ]. The transfer of these local grafts has the potential to weaken the foot, reduce stability and in turn affect a patient’s balance and gait [ 2 , 13 , 34 ]. The use of the semitendinosus, therefore has the advantage that it does not directly alter foot function and that it has also been reported to regenerate [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re-ruptures using a semitendinosus autograft is a viable alternative to pre-existing techniques

Nilsson

Gunnarsson

Carmont

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Achilles tendon ruptures are termed chronic after a delay in treatment for more than 4 weeks. The literature advocates surgical treatment with reconstruction to regain ankle push-off strength. The preferred technique is, however, still unknown and is often individualized. This study aims to present the technique and clinical outcome of an endoscopically assisted free semitendinosus reconstruction of chronic Achilles tendon rupture and Achilles tendon re-ruptures with delayed representation. It is hypothesized that the presented technique is a viable and safe alternative for distal Achilles tendon ruptures and ruptures with large tendon gaps. Method Twenty-two patients (13 males and 9 females) with a median (range) age of 64 (34–73) treated surgically with endoscopically assisted Achilles tendon reconstruction using a semitendinosus autograft were included. The patients were evaluated at 12 months post-operatively for Achilles tendon Total Rupture Score (ATRS), calf circumference, Achilles Tendon Resting Angle (ATRA), heel-rise height and repetitions together with tendon length determined by ultrasonography, concentric heel-rise power and heel-rise work. Results The patients reported a median (range) ATRS of 76 (45–99) out of 100. The median (range) ATRA on the injured side was 60° (49°-75°) compared with 49.5° (40–61°), p < 0.001, on the non-injured side. Eighteen out of 22 patients were able to perform a single-leg heel-rise on the non-injured side. Sixteen patients out of those 18 (89%) were also able to perform a single heel-rise on the injured side. They did, however, perform significantly lower number of repetitions compared with the non-injured side with a median (range) heel-rise repetitions of 11 (2–22) compared with 26 (2–27), (p < 0.001), and a median (range) heel-rise height of 5.5 cm (1.0–11.0 cm) compared with 9.0 cm (5.0–11.5 cm), (p < 0.001). The median calf circumference was 1.5 cm smaller on the injured side, 37.5 cm compared with 39 cm, when medians were compared. The median (range) tendon length of the injured side was 24.8 cm (20–28.2 cm) compared with 22 cm (18.4–24.2 cm), (p < 0.001), on the non-injured side. Conclusion The study shows that endoscopically assisted reconstruction using a semitendinosus graft to treat chronic Achilles tendon ruptures and re-ruptures with delayed representation produces a satisfactory outcome. The technique can restore heel-rise height in patients with more distal ruptures or large tendon defects and is therefore a viable technique for Achilles tendon reconstruction. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re-ruptures using a semitendinosus autograft is a viable alternative to pre-existing techniques

Nilsson

Gunnarsson

Carmont

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…9 A meta-analysis of clinical studies found significantly higher complication rates when Achilles reconstruction was performed with FHL transfer alone (15.87%) compared with FHL transfer with additional augmentation (11.67%). 1 In 4 patients who were excluded from this study, the senior author performed simultaneous FHL transfer with dual semitendinosus transfer based on the potential for added vascularity and construct strength. However, good outcomes with dual semitendinosus transfer alone led to abandonment of the additional procedure, and the FHL was left for later salvage if needed.…”

Section: Discussionmentioning

confidence: 99%

Dual Semitendinosus Allograft Reconstruction of Chronic Achilles Tendon Ruptures: Operative Technique and Outcomes

et al. 2022

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Background: Dual semitendinosus allograft reconstruction of chronic Achilles tendon ruptures has several potential benefits including superior tensile strength compared with a turndown construct and avoidance of the morbidity and operative time associated with autograft augmentation. We present a series of chronic Achilles tendon ruptures reconstructed with dual semitendinosus allograft. Methods: We retrospectively reviewed the charts of patients aged 18 years and older who underwent reconstruction of chronic Achilles tendon ruptures using dual semitendinosus allograft. The primary outcome of this study was to evaluate the need for revision surgery. Secondary outcomes included patient-reported outcomes, for which Achilles Tendon Rupture Scores (ATRS) were collected at final follow-up. Nine patients with a mean age of 58.9 (range, 43-75) years met inclusion criteria. Results: Median follow-up was 66 months (range, 27-121 months). One patient (11.1%) required revision reconstruction after sustaining graft failure 9.5 years after her index procedure, and 1 patient reported a poor ATRS score at the 27-month final follow-up despite an intact surgical repair. At final follow-up, no patient required the use of an assistive device for ambulation or a walking boot. The median ATRS at final follow-up was 93 (range, 30-100). Discussion: Good clinical outcomes without rerupture were observed in 7 of 9 patients (77.8%) at short- to midterm follow-up, suggesting that dual semitendinosus allograft reconstruction is a viable option for the reconstruction of chronic Achilles tendon tears. Level of Evidence: Level IV, case series.

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“…As shown in past studies, it is practically difficult to obtain the number of cases of foot and ankle diseases collectively, so many studies of foot and ankle diseases are single-arm studies and these research results are improving our clinical practice and research activities. 2,3,25,28,34 The other limitation was this study did not describe the time frame to return to sport because all subjects included in this study were nonathletes. Although patients with chronic Achilles tendon rupture are relatively rare, a multicenter matched-pair study could be an option to address these limitations.…”

Section: Discussionmentioning

confidence: 99%

Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

Tsukada

Yasui

Kubo

et al. 2021

Foot & Ankle Orthopaedics

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Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

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Clinical outcomes of chronic Achilles tendon rupture treated with flexor hallucis longus grafting and flexor hallucis longus grafting plus additional augmentation: A meta-analysis

Cited by 19 publications

References 37 publications

Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re-ruptures using a semitendinosus autograft is a viable alternative to pre-existing techniques

Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re-ruptures using a semitendinosus autograft is a viable alternative to pre-existing techniques

Dual Semitendinosus Allograft Reconstruction of Chronic Achilles Tendon Ruptures: Operative Technique and Outcomes

Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

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