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

Abstract

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.

Letter to the editor

“…Dear Editor, we have read recently published article, entitled Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re-ruptures using a semitendinosus autograft is a viable alternative to pre-existing techniques by Nilsson et al [1] with interest. However, as experts in the field of Achilles tendon reconstructions, we felt obligated to express our concerns about this publication.…”

“…With specific graft stabilization, the patients are able to walk without crutches from day 1 after the surgery. Complications: two out of 22 patients in the presented study [ 1 ] were treated with oral antibiotics. Does it mean that they had wound infection?…”

“…Complications: two out of 22 patients in the presented study [ 1 ] were treated with oral antibiotics. Does it mean that they had wound infection?…”

A Comprehensive Evaluation of Minimally Invasive Achilles Tendon Reconstruction with Hamstring Graft Indicates Satisfactory Long-Term Outcomes

“…Moreover, it has been proven that better repair effects through external implementation of growth factor and/or stem cell therapy (during the tendon healing) can be achieved [ 22 ]. Several authors presented restoration of full function of the operated Achilles tendon and the overall patient satisfaction when using semitendinosus tendon grafts [ 18 , 23 , 24 , 25 ] or gracilis tendon grafts [ 26 , 27 ]. However, to our knowledge, this is the first study which presents a detailed, versatile clinical, functional and isokinetic assessment of patients after Achilles tendon reconstruction.…”

“…However, to our knowledge, this is the first study which presents a detailed, versatile clinical, functional and isokinetic assessment of patients after Achilles tendon reconstruction. Multiple assessments, which described the outcomes of the Achilles reconstruction were based on two most popular subjective, patient-reported scales: Achilles tendon Total Rupture Score (ATRS) and American Orthopedic Foot and Ankle Society Score (AOFAS), combined with isokinetic tests or functional tests [ 15 , 16 , 17 , 18 , 19 , 22 , 23 , 24 , 25 , 26 , 27 ]. However, in these studies, a clear contradiction was observed between the subjective and the objective outcomes, which, in our opinion, might be the result of an insufficient number of the Achilles tendon parameters tested.…”