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Review
. 2017 Jul 31:11:660-669.
doi: 10.2174/1874325001711010660. eCollection 2017.

Chronic Achilles Tendon Rupture

Nicola Maffulli  1   2 , Alessio Giai Via  3 , Francesco Oliva  3
Affiliations
Review

Chronic Achilles Tendon Rupture

Nicola Maffulli et al. Open Orthop J. .

Abstract

Background: The Achilles tendon, the largest and strongest tendon in the human body, is nevertheless one of the tendons which most commonly undergoes a complete subcutaneous tear. Achilles tendon ruptures are especially common in middle aged men who occasionally participate in sport. Even though Achilles tendon ruptures are frequent, up to 25% of acute injuries are misdiagnosed, and present as chronic injuries.

Methods: This is a review article about diagnosis and management of chronic Achilles tendon ruptures. Minimally invasive Achilles tendon reconstruction is discussed.

Results: The optimal surgical procedure is still debated, however, less invasive peroneus brevis reconstruction technique and free hamstring autograft provide good functional results.

Conclusion: The management of chronic ruptures is more demanding than acute tears, because of the retraction of the tendon ends, and the gap makes primary repair impossible. Wound complications and infections are frequent after open procedures. Minimally invasive treatments provide good functional results and lower complications rate.

Keywords: Achilles tendon; Chronic ruptures; Minimally-invasive surgery; Neglected injury; Tendon ruptures; Tendon transfer.

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Figures

Fig. (1)
Fig. (1)
A) The first incision is at the proximal end of the palpable tendon stump, as near as possible the medial border of the Achilles tendon. The second incision is lateral to the distal end of the tendon stump. B) Final appearance of surgical approaches.
Fig. (2)
Fig. (2)
A) The third longitudinal incision is over the base of the fifth metatarsal. B) The peroneus brevis tendon insertion is exposed and harvested.
Fig. (3)
Fig. (3)
The proximal and distal Achilles tendon stumps are mobilized and exposed. The gap between the two tendon stumps are measured with the ankle in maximum equinus. *: Achilles tendon stumps.
Fig. (4)
Fig. (4)
Final appearance of the peroneus brevis tendon transfer.
Fig. (5)
Fig. (5)
The semitendinosus tendon is harvested with the patient prone, through a vertical, 2.5-3 cm longitudinal incision over the pes anserinus.
Fig. (6)
Fig. (6)
The tendon graft is passed from lateral to medial into the proximal Achilles tendon stump. AT: Achilles tendon; ST: Semitendinosus tendon graft.
Fig. (7)
Fig. (7)
The tendon graft is passed beneath the intact skin bridge from the proximal to the distal incision, and it passed through a transverse tenotomy into the distal stump from the medial to the lateral side. P: Proximal Achilles tendon stump; D: Distal Achilles tendon stump; ST: Semitendinosus tendon graft.
Fig. (8)
Fig. (8)
Final appearance of reconstruction of chronic Achilles tendon rupture with semitendinosus tendon graft.
See this image and copyright information in PMC

References

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