Management of Neglected Achilles Tendon Division: Assessment of Two Novel and Innovative Techniques

Abstract

Objective. Repair of injured Achilles tendon in neglected cases is one of the difficult and challenging procedures for surgeon. Here, we share our experience with the use of two innovative techniques for repair of chronic rupture of Achilles tendon. Design. Prospective Study. Setting. Tertiary care hospital. Patients. Twelve patients with chronic Tendo Achilles rupture were followed up over a period of three to five years. Intervention. Patients were divided in two groups, A and B. In Group A, the repair was done with Gastroc-soleus turndown flap and weaving with Plantaris tendon graft and in Group B, with modified Kessler’s technique strengthened with the free plantaris tendon graft. Outcome Assessment. Clinically and by Modified Rupp Scoring system. Results. At an average follow-up of 4 years (Group A, 3.7 and Group B, 4.4 years), the majority of the patients had excellent to good results as assessed with Modified Rupp Scoring with few minor complications in both the groups. There was no significant difference in the baseline variables such as age and gender and also in the Rupp’s score between the two groups. Conclusion. The two techniques are novel and simple and have been found to be useful for repair of chronically ruptured Achilles tendon.

Functional and MRI follow-up after reconstruction of chronic ruptures of the Achilles tendon Myerson type III using the triple-loop plantaris tendon wrapped with central turndown flap: a case series

“…Several techniques have been described in the literature for the management of such condition [ 5 ]. The primary goal of such techniques was restoration of both function and strength of the gastrocnemius-soleus complex by maintaining the optimal length-tension relationship [ 10 ].…”

“…In Myerson type III, the basic requirement is to bridge the defect by either biological tissue or synthetic material providing satisfactory strength that allows full range of tendon excursion. A number of options have evolved for such situation including either biological, synthetic, allogeneic tissues or combinations of any two of them [ 5 , 6 , 11 , 12 ].…”

“…Its only drawback is the possibility of its absence in some patients [ 13 , 14 ]. On the other hand, the use of turndown flap has been utilized by many authors and exhibited satisfactory results [ 5 , 15 ].…”

“…Jain et al [ 5 ] had proposed a similar technique for the management of chronic Achilles tendon ruptures with defects longer than 2 cm. However, they utilized free plantaris tendon graft with a circular configuration enveloping the turndown flap.…”

“…Ideally, the technique proposed for reconstruction of a chronic Achilles tendon rupture should be both simple and less morbid. The aim of such procedure should be retaining normal functional capacity within a relatively short time [ 5 , 6 ].…”