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. 2019 Dec 6;7(12):2325967119887673.
doi: 10.1177/2325967119887673. eCollection 2019 Dec.

Comparison of Gastrocnemius Turn Flap and Hamstring Graft for the Treatment of Kuwada Type 3 Chronic Ruptures of the Achilles Tendon: A Retrospective Study

Lu Bai  1 , Siyao Guan  1 , Tian You  1 , Wentao Zhang  1 , Peng Chen  1
Affiliations

Comparison of Gastrocnemius Turn Flap and Hamstring Graft for the Treatment of Kuwada Type 3 Chronic Ruptures of the Achilles Tendon: A Retrospective Study

Lu Bai et al. Orthop J Sports Med. .

Abstract

Background: Chronic Achilles tendon rupture is challenging to repair, and many procedures have been suggested to fill the gap that separates the distal and proximal ends of the ruptured tendon.

Purpose: To compare clinical outcomes between the free hamstring graft (HG) and gastrocnemius turn flap (GTF) procedures in the treatment of chronic Achilles tendon rupture.

Study design: Cohort study; Level of evidence, 3.

Methods: This retrospective study included 26 patients (25 males, 1 female; mean age, 36.7 years; range, 22-53 years) with Kuwada type 3 chronic rupture of the Achilles tendon. A total of 11 patients underwent GTF surgery, whereas 15 patients underwent HG surgery. Follow-up assessments were conducted at 3, 6, and 12 months postoperatively.

Results: The complication rate was significantly higher in the GTF group compared with the HG group (27.2% vs 6.6%, respectively; χ2 = 12.462; P = .001). At the 3-month follow-up, the degree of ankle dorsiflexion was significantly higher in the HG group than in the GTF group (t = 3.144; P = .004). At 6-month and 1-year follow-up, no significant differences in ankle function were seen between the 2 groups.

Conclusion: Hamstring tendon graft is associated with better early recovery of dorsiflexion compared with GTF. The long-term clinical outcomes of these 2 procedures are similar.

Keywords: chronic Achilles tendon rupture; functional outcome; gastrocnemius turn flap; hamstring graft.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by a grant from the Foundation of Shenzhen Science and Technology Research (No. JCYJ20160428173808742), the Foundation of Shenzhen Health and Family Planning Commission (SZXJ2018085), the Sanming Project of Medicine in Shenzhen (No. SZSM201612078), and the Foundation of Chinese Medicine Administration Bureau Guangdong Province (20161208). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Illustration of the gastrocnemius turn flap procedure. (A) An incision is made to reveal the gap between the distal and proximal ends of the Achilles tendon. (B) After debridement of the scar tissue, the gastrocnemius flap is turned down. (C) The gastrocnemius flap is sutured to fill the gap.
Figure 2.
Figure 2.
Illustration of hamstring graft procedure. (A) The hamstring autograft is removed with the patient in the prone position. (B) The defect is not incised, and the tendon is percutaneously passed through the gap. (C) After fixation of the graft, the continuity of the Achilles tendon is restored.
See this image and copyright information in PMC

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