V‐Y Tendon Plasty for Reconstruction of Chronic Achilles Tendon Rupture: A Medium‐term and Long‐term Follow‐up

Abstract

Objective To evaluate the surgical results of V‐Y tendon plasty in the treatment of chronic Achilles tendon rupture during medium and long‐term follow‐up. Methods Between June 2005 and September 2017, 20 patients with chronic Achilles tendon rupture underwent V‐Y tendon plasty in our hospital. The mean injury‐to‐surgery time was 20.4 weeks (range, 4–96 weeks). The Matles test and an improved Thompson test was used to examine Achilles tendon rupture. These patients were not able to stand on the tiptoes of the injured lower extremity. X‐ray tests ruled out the chance of fracture and were used to examine the Kager triangle. MRI was used to confirm the final diagnosis. The function of the ankle and the foot was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Achilles Tendon Total Rupture Score (ATRS). V‐Y tendon plasty for Achilles tendon reconstruction was performed. A below‐knee cast was used to keep the ankle in plantar flexion (up to 20°) for 4 weeks. Non‐weight‐bearing exercise was allowed with crutches. After 4 weeks, partial weight‐bearing was allowed. Physical exercises were performed under rehabilitation guidelines. At 10–12 weeks postoperation, patients began to return to daily life activity levels without restrictions. Preoperative and postoperative MRI was obtained. Results The mean follow‐up period was 32.8 months. The mean operative gap of the Achilles tendon after debridement was 5 cm (range, 4–9 cm), with 85% of the gap less than or equal to 6 cm. The mean AOFAS score increased from 59.25 ± 12.28 preoperatively to 96.55 ± 3.75 at final follow‐up ( P < 0.05). The mean ATRS score increased from 39.55 ± 14.21 preoperatively to 94.05 ± 4.89 at final follow‐up ( P < 0.05). All patients had no recurrent Achilles tendon rupture during the follow up. No patient had developed serious complications, such as sural nerve injury or deep vein thrombosis. Patients were able to return to daily life activity levels without restrictions. At the latest follow‐up, all patients were able to perform repetitive single heel rise on the involved limb, and to walk without a visible limp. All of the postoperative MRI showed the continuity of the Achilles tendon with no signs of cysts or inflammation, indicating perfect healing at the final follow‐up. Conclusions V‐Y tendon plasty can be used in most cases of chronic Achilles tendon rupture. It yields satisfactory functional results and low complication rates. The advantage of this procedure is that it is an easy and economic method without the need for expensive synthetic implants. V‐Y tendon plasty should be considered an acceptable first‐choice treatment.

Evaluation of the effectiveness of inveterate Achilles tendon rupture V-Y plasty with immediate subsequent weight-bearing and rehabilitation. Case study

“…Despite the fact that the Achilles tendon rupture is one of the most common lower limb injuries, as the above cas es show, doctors still make mistakes in their diagnosis and treatment. There is still a lot of controversy about surgical vs conservative treatment [6].…”

Clinical Outcomes in Patients With Minimally Invasive Surgical Approach Combined With Plantar Tendon Transfer Repairing Neglected Achilles Tendon Rupture Compared to the Conventional Approach of V-Y Tendon Plasty: A Retrospective Study With Two Years Follow-Up

“…Various operative techniques have been reported to repair NATR with a good outcome 8,9,[19][20][21][22] . For instance,V-Y tendon plasty combined with gastrocnemius aponeurosis turndown restoring the tendon length was reported by Bilgin et al for repairing tendon defects of 4 to 6 cm successfully 22 .…”

“…It's suggested to be excised in operation clearly, though the end-to-end repair is di cult to perform. The conventional surgery of V-Y tendon plasty has been reported by some works of literature to repair NATR with a favorable clinical e cacy 8,9 . However, a 10-15cm longitudinal, slightly curved central skin incision would be created to operate the surgery, which will lead to severe trauma and a long postoperative scar on the skin of the posterior leg undoubtedly.…”

The Surgical Care Practitioner role in Achilles tendon re-rupture: A case study

“…The main aim of surgical repair is to restore anatomic continuity and tension for good single leg function and symmetrical gait (Guclu et al 2016). Several procedures exist to achieve these effects, such as V-Y plasty, fascial turndown flap, tendon transfer, allograft and autograft reconstruction and synthetic graft augmentation (Lin et al 2019). John underwent V-Y plasty (Figure 4).…”

“…John underwent V-Y plasty (Figure 4). This is the recommended operative method for chronic (four to six weeks old) ruptures with a defect of up to 9cm, because it produces satisfactory functional outcomes and has a low complication rate (Lin et al 2019).…”