Revision Achilles Tendon Repair Using Posterior Tibial Tendon Allograft and Flexor Hallucis Longus Transfer

Meter, Joseph; Bascharon, Randa; Amesur, Ajit; Gupta, Shivali; Arias, Daniel Chávez; Anthony, Taylor; Hoang, Victor

doi:10.1016/j.eats.2021.11.001

Cited by 4 publications

(2 citation statements)

References 8 publications

(15 reference statements)

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“…19 The most common tendons used as allografts for ACL reconstruction include bone−patellar tendon–bone (BPTB), hamstring (semitendinosus with or without gracilis tendon), tibialis anterior, tibialis posterior, and Achilles tendon. 10,11 Additional tendons with use as autografts for a range of reconstructive applications, such as fibularis longus, 18 flexor hallucis longus, 28 plantaris, 1,22,31 and flexor digitorum longus, 16 may have uses as allografts for specific cases of ACL injury. The final decision on graft source and type needs to be personalized and cater to the functional demands and age of the patient (ie, withstand certain loads and be appropriately sized), but it is also heavily influenced by surgeon preference.…”

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confidence: 99%

Challenging the Perceptions of Human Tendon Allografts: Influence of Donor Age, Sex, Height, and Tendon on Biomechanical Properties

Ashton

Blaker

Hartnell³

et al. 2023

Am J Sports Med

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Background: The use of allograft tendons has increased for primary and revision anterior cruciate ligament reconstruction, but allograft supply is currently limited to a narrow range of tendons and donors up to the age of 65 years. Expanding the range of donors and tendons could help offset an increasing clinical demand. Purpose: To investigate the effects of donor age, sex, height, and specific tendon on the mechanical properties of a range of human lower leg tendons. Study Design: Descriptive laboratory study. Methods: Nine tendons were retrieved from 39 fresh-frozen human cadaveric lower legs (35 donors [13 female, 22 male]; age, 49-99 years; height, 57-85 inches [145-216 cm]) including: Achilles tendon, tibialis posterior and anterior, fibularis longus and brevis, flexor and extensor hallucis longus, plantaris, and flexor digitorum longus. Tendons underwent tensile loading to failure measuring cross-sectional area (CSA), maximum load, strain at failure, ultimate tensile strength, and elastic modulus. Results from 332 tendons were analyzed using mixed-effects linear regression, accounting for donor age, sex, height, and weight. Results: Mechanical properties were significantly different among tendons and were substantially greater than the effects of donor characteristics. Significant effects of donor sex, age, and height were limited to specific tendons: Achilles tendon, tibialis posterior, and tibialis anterior. All other tendons were unaffected. The Achilles tendon was most influenced by donor variables: greater CSA in men (β = 15.45 mm2; Šidák adjusted P < .0001), decreased maximum load with each year of increased age (β = −17.20 N per year; adjusted P = .0253), and increased CSA (β = 1.92 mm2 per inch; adjusted P < .0001) and maximum load (β = 86.40 N per inch; adjusted P < .0001) with each inch of increased height. Conclusion: Mechanical properties vary significantly across different human tendons. The effects of donor age, sex, and height are relatively small, are limited to specific tendons, and affect different tendons uniquely. The findings indicate that age negatively affected only the Achilles tendon (maximum load) and challenge the exclusion of donors aged >65 years across all tendon grafts. Clinical Relevance: The findings support including a broader range of tendons for use as allografts for anterior cruciate ligament reconstruction and reviewing the current exclusion criterion of donors aged >65 years.

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confidence: 99%

Challenging the Perceptions of Human Tendon Allografts: Influence of Donor Age, Sex, Height, and Tendon on Biomechanical Properties

Ashton

Blaker

Hartnell³

et al. 2023

Am J Sports Med

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“… 5 , 6 Re-ruptures occurring post-surgery inherently necessitate more challenging approaches compared to those occurring after nonoperative management of ATR. 7 This leads to additional surgical procedures and hospitalization followed by vigorous rehabilitation treatment, 5 which probably increases the medical expenses.…”

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confidence: 99%

Factors associated with Achilles tendon re-rupture following operative fixation

Choi,

Kwon,

Choi

et al. 2024

Bone Joint Res

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AimsAchilles tendon re-rupture (ATRR) poses a significant risk of postoperative complication, even after a successful initial surgical repair. This study aimed to identify risk factors associated with Achilles tendon re-rupture following operative fixation.MethodsThis retrospective cohort study analyzed a total of 43,287 patients from national health claims data spanning 2008 to 2018, focusing on patients who underwent surgical treatment for primary Achilles tendon rupture. Short-term ATRR was defined as cases that required revision surgery occurring between six weeks and one year after the initial surgical repair, while omitting cases with simultaneous infection or skin necrosis. Variables such as age, sex, the presence of Achilles tendinopathy, and comorbidities were systematically collected for the analysis. We employed multivariate stepwise logistic regression to identify potential risk factors associated with short-term ATRR.ResultsFrom 2009 to 2018, the short-term re-rupture rate for Achilles tendon surgeries was 2.14%. Risk factors included male sex, younger age, and the presence of Achilles tendinopathy.ConclusionThis large-scale, big-data study reaffirmed known risk factors for short-term Achilles tendon re-rupture, specifically identifying male sex and younger age. Moreover, this study discovered that a prior history of Achilles tendinopathy emerges as an independent risk factor for re-rupture, even following initial operative fixation.Cite this article: Bone Joint Res 2024;13(7):315–320.

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The research status of biodegradable polymers in repair of Achilles tendon defects

Zhang

Zhu

Chen

et al. 2023

International Journal of Polymeric Materials and Polymeric Biom

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Revision Achilles Tendon Repair Using Posterior Tibial Tendon Allograft and Flexor Hallucis Longus Transfer

Cited by 4 publications

References 8 publications

Challenging the Perceptions of Human Tendon Allografts: Influence of Donor Age, Sex, Height, and Tendon on Biomechanical Properties

Challenging the Perceptions of Human Tendon Allografts: Influence of Donor Age, Sex, Height, and Tendon on Biomechanical Properties

Factors associated with Achilles tendon re-rupture following operative fixation

The research status of biodegradable polymers in repair of Achilles tendon defects

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