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

Abstract

Achilles tendon xanthomas are rarely seen masses that are highly associated with hyperlipidemia. They are manifested in two types: Xanthomas developed secondary to familial hypercholesterolemia and cerebrotendinous xanthomatoses. In this report, we present a case of bilateral Achilles tendon xanthoma secondary to familial hypercholesterolemia and resection along with a portion of the Achilles tendon. The patient was a 49-year-old male who presented to our clinic with complaints of difficulty walking and swelling in both heels. The swellings had started insidiously without a trauma history. The xanthomas were operated at different time points, albeit with the same surgical technique. Quadriceps tendon graft and flexor hallucis longus transfer was used for autografting. Xanthoma should be considered in cases with swellings in the Achilles tendon. Total resection is necessary to avoid recurrence of the xanthomas. Large gaps formed after resection can be filled and reconstruction of the Achilles tendon can be realized using quadriceps tendon autografts (containing bony fragments) and the flexor hallucis longus tendon. We believe a functional ankle and an Achilles tendon can be achieved with the employment of this technique.

Imaging of bilateral tendoachilles xanthomatosis in a young woman

“…e usual options are gracilis, the tensor fascia lata, FHL, and semitendinous for reconstruction. [9] Dinçel et al [10] proposed tendon reconstruction in case of a large defect with quadriceps…”

Xanthoma of Tendoachilles: Management and Follow-Up

“…The tensor fascia lata, FHL, gracilis, and semitendinous are the usual options for reconstruction [34]. Dinçel et al [35] recommend the use of quadriceps tendon graft with bony fragments when the defect is large. FHL transfer was described by Pearce et al [36].…”

“…Scagenelli et al [38] have found the reconstruction by using allograft satisfactory in their study. Dincel et al [35] have shown good results in bilateral xanthoma excision and reconstruction done by quadriceps tendon with bone fragment in 1 side and other side reconstruction with FHL transfer in different stages. FHL tendon has definite advantages in the Achilles tendon reconstruction than other existing options as (1) it is close to the Achilles tendon; easy to harvest, (2) the FHL muscle has the same function as the triceps surae; same excursion, (3) it has adequate strength; hypertrophy of FHL occurs to bear the strength of TA, and (4) it has the same axis of moving with the Achilles tendon [39].…”

Xantoma del tendón de aquiles bilateral: Debut de xantomatosis cerebrotendinosa

“…Están altamente asociados con la hiperlipidemia que se puede manifestar como sitosterolemia, hipercolesterolemia familiar o xantomatosis cerebrotendinosa. 1 Esa última, es una enfermedad autosómica recesiva derivada de la mutación del gen del esterol 27-hidroxilasa (CYP27). Tiene como consecuencia la acumulación de colesterol y colestanol en el cerebro, los ojos, los tendones y otros tejidos.…”