J Korean Foot Ankle Soc.  2021 Jun;25(2):80-88. 10.14193/jkfas.2021.25.2.80.

Reconstructive Strategies for Chronic Achilles Tendon Rupture

• Cho BK
• Ahn BH

• KMID: 2516645
• DOI: http://doi.org/10.14193/jkfas.2021.25.2.80

Abstract

Chronic Achilles tendon rupture is likely to result in functional impairment in gait and sports activity. The presence of a large defect secondary to retraction of the tendon ends, atrophy of the calf muscles, and vulnerable vascularity of the soft tissue envelope make it a challenging problem to treat. Surgical reconstruction aims to restore the length and tension of the gastrocnemius-soleus complex. Various surgical treatment options have been described, depending on several factors, including residual gap size after scar tissue removal, remaining tissue quality, and vascularity. Despite good results being reported, there is a lack of high-level, evidence-based clinical guidelines available to select the first-line surgical procedure. This paper overviews the current available surgical options for patients with chronic Achilles tendon rupture.

Keyword

Achilles tendon; Rupture; Treatment; Surgery

Figure

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  Figure. 1 Preoperative magnetic resonance image (A) and intraoperative photograph (B) showing the gap size between the Achilles tendon stumps.

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  Figure. 2 (A, B) Intraoperative photographs showing the direct end-to-end repair after a manual traction of the Achilles tendon stumps.

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  Figure. 3 (A~C) Intraoperative photographs showing the V-Y advancement of the gastrocnemius fascia to repair the Achilles tendon stumps.

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  Figure. 4 (A~D) Intraoperative photographs showing the harvest of dual strips of the gastrocnemius fascia, and the turn-down distally with a 2-cm cuff.

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  Figure. 5 (A, B) Intraoperative photographs showing a combined procedure using gastrocnemius fascia turn-down flap and flexor hallucis longus tendon transfer.

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  Figure. 6 (A, B) Intraoperative photographs showing the Achilles tendon reconstruction using free semitendinosus tendon auto-graft.

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