The Neglected Achilles Tendon Rupture Repaired With Allograft: A Review of 14 Cases

Ofili, Kene; Pollard, Jason D.; Schuberth, John M.

doi:10.1053/j.jfas.2016.01.001

Cited by 23 publications

(16 citation statements)

References 21 publications

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“…Especially in the cases which involve severe tissue destructuring, so tendon suture augmentation procedures should be considered. [6][7][8] From the analysis of literature augmentation methods we can exploit tissue adjacent to the tendon to be repaired (V-Y advancement technique, tendon transfers) or involve the use of grafts divided into autografts (fascia Lata, hamstring tendons), allografts (membranes of various sizes and thicknesses) and synthetic material (Gore-Tex, polyurethan urea, polylactic acid, etc.). 21,22 Analyzing the advantages and disadvantage of the above-mentioned augmentation methods the first one may be associated with morbidity problems at the harvest site.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical augmentation aims to increase the stress resistance of the repair performed, while biological augmentation aims to stimulate the "re-tendonization" process. [6][7][8] To date, various types of biomaterials have be used successfully. A distinction is made between synthetic and biological grafts.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, it must be implemented in the operative phase using biomaterials to achieve mechanical and biological augmentation. Mechanical augmentation aims to increase the stress resistance of the repair performed, while biological augmentation aims to stimulate the “re‐tendonization” process 6–8 …”

Section: Introductionmentioning

confidence: 99%

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One Step Double Augmentation with Human Dermis Allograft and Homologous PRP in Misdiagnosed and or Chronic Achilles Tendon Ruptures

Lughi,

Bondioli,

Moretti

et al. 2023

Orthopaedic Surgery

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ObjectiveMisdiagnosed/chronic Achilles tendon injuries are rare and disabling for patients. The surgical treatment of these rare injuries aims to ensure the tendon heals mechanically and biologically. This is the prerequisite for a good clinical and functional outcome and reduces recurrences. The main aim of the study is to present a surgical technique that has proven to be original, reproducible, and capable of guaranteeing solid tendon repair and optimal tissue regeneration.MethodsWe treated five patients, four males and one female, with the one‐step double augmentation technique. All patients of this study complained of pain, but above all severe functional limitation that Achilles tendon injury had been causing for more than a month. In this study, we widely described the surgical technique, original and not found in the literature, which provides a biological graft (allograft of decellularized dermis) and homologous, thrombin‐activated, platelet‐rich plasma (H‐PRP) in a single step. Surgical approach, always used by the first author, respected predefined steps: careful dissection and preparation of the peritendinous tissues from suture to the end of the procedure, tenorrhaphy, and augmentation with allopatch to obtain a mechanically effective repair to avoid recurrences, and finally “biological” augmentation with a unit of homologous, thrombin activated, PRP. We offered to all patients a regenerative rehabilitation program post‐operatively.ResultsAll patients were evaluated clinically (functional clinical tests and questionnaires) and instrumentally (elastic‐sonography and perfusion MRI). The obtained results have been evaluated at a minimum follow‐up of 18 months and a maximum of 24 months. In all patients pain was resolved, and district function and kinetic chains improved with resumption of daily activities, work, and sports.ConclusionThe present study confirmed the regenerative potential of decellularized dermis allograft and PRP (homologous and thrombin‐activated). The same approach can also be exploited in cases of severe tendon destructuring and limited “intrinsic” regenerative potential at any age. The proposed one‐step surgical technique of a double augmentation therefore appears useful, safe, reproducible, and applicable in all chronic tendon lesions with low regenerative potential.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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One Step Double Augmentation with Human Dermis Allograft and Homologous PRP in Misdiagnosed and or Chronic Achilles Tendon Ruptures

Lughi,

Bondioli,

Moretti

et al. 2023

Orthopaedic Surgery

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“…No other complications were reported. Ofili et al (24) used Achilles tendon allografts to repair neglected Achilles tendon ruptures in 14 patients with an average of 6.9 months between the injury and surgery. Favorable outcomes were reported, with all patients able to bear weight and perform a single-leg heel rise.…”

Section: Discussionmentioning

confidence: 99%

Achilles Tendon Augmented Repair Using Human Acellular Dermal Matrix: A Case Series

Cole

Samsell

Moore

2018

The Journal of Foot and Ankle Surgery

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Achilles tendon ruptures are common in the general population, especially among members of the older demographic occasionally active in sports. Operative treatments provide a lower incidence of rerupture than do nonoperative treatments, although surgical complications remain a concern. The use of a human acellular dermal matrix to augment Achilles tendon repair might reduce the incidence of complications. In the present case series, we describe the outcomes of 9 patients who underwent Achilles tendon repair with acellular dermal matrix augmentation. Functional outcomes were evaluated using the Foot Function Index-Revised long form, and the clinical results were recorded. After a mean average follow-up period of 14.4 (range 12.0 to 20.0) months, the mean Foot Function Index-Revised long form score was 33.0% ± 4.2%. No cases of rerupture or complications that required additional treatment occurred during the observation period. The outcomes we have presented support further evaluation beyond this case series for using a human acellular dermal matrix to augment Achilles tendon repairs.

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“…As an allograft, Achilles tendon has been used to reconstruct joints 12,13 and to repair rotator cuff 14 , patellar tendon 15 , and anterior cruciate ligament 16 , but only occasionally transplanted to replace an Achilles tendon. In a group of 14 cases, an Achilles allograft was transplanted to reconstruct a large Achilles defect (7.0 + 3 cm) 17 . The patients resumed full weight bearing in 13 wk and achieved single heel raise in 27 wk.…”

Section: Introductionmentioning

confidence: 99%

Orthotopic Transplantation of Achilles Tendon Allograft in Rats

et al. 2018

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The biology and function of orthotopic transplantation of Achilles tendon allograft are unknown. Particularly, the revitalization of Achilles allograft is a clinical concern. Achilles allografts were harvested from donor rats and stored at −80 °C. Subcutaneous adipose tissue was harvested from the would-be allograft recipient rats for isolation of mesenchymal stem cells (MSCs). MSCs were cultured with growth differentiation factor-5 (GDF-5) and applied onto Achilles allografts on the day of transplantation. After the native Achilles tendon was resected from the left hind limb of the rats, Achilles allograft, with or without autologous MSCs, was implanted and sutured with calf muscles proximally and calcaneus distally. Animal gait was recorded presurgery and postsurgery weekly. The animals were sacrificed at week 4, and the transplanted Achilles allografts were collected for biomechanical testing and histology. The operated limbs had altered gait. By week 4, the paw print intensity, stance time, and duty cycle (percentage of the stance phase in a step cycle) of the reconstructed limbs were mostly recovered to the baselines recorded before surgery. Maximum load of failure was not different between Achilles allografts, with or without MSCs, and the native tendons. The Achilles allograft supplemented with MSCs had higher cellularity than the Achilles allograft without MSCs. Deposition of fine collagen (type III) fibers was active in Achilles allograft, with or without MSCs, but it was more evenly distributed in the allografts that were incubated with MSCs. In conclusion, orthotopically transplanted Achilles allograft healed with host tissues, regained strength, and largely restored Achilles function in 4 wk in rats. It is therefore a viable option for the reconstruction of a large Achilles tendon defect. Supplementation of MSCs improved repopulation of Achilles allograft, but large animal models, with long-term follow up and cell tracking, may be required to fully appreciate the functional benefits of MSCs.

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The Neglected Achilles Tendon Rupture Repaired With Allograft: A Review of 14 Cases

Cited by 23 publications

References 21 publications

One Step Double Augmentation with Human Dermis Allograft and Homologous PRP in Misdiagnosed and or Chronic Achilles Tendon Ruptures

One Step Double Augmentation with Human Dermis Allograft and Homologous PRP in Misdiagnosed and or Chronic Achilles Tendon Ruptures

Achilles Tendon Augmented Repair Using Human Acellular Dermal Matrix: A Case Series

Orthotopic Transplantation of Achilles Tendon Allograft in Rats

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