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. 2021 Mar 4;6(1):2473011421993458.
doi: 10.1177/2473011421993458. eCollection 2021 Jan.

Hamstring Autograft Applications for Treatment of Achilles Tendon Pathology

Carson M Rider  1 , Oliver B Hansen  1 , Mark C Drakos  1
Affiliations

Hamstring Autograft Applications for Treatment of Achilles Tendon Pathology

Carson M Rider et al. Foot Ankle Orthop. .
No abstract available

Keywords: sports; tendon disorders.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
Hamstring harvest in the prone position. (A) The incision is drawn parallel to the medial face of the tibia, halfway between the tibial tubercle and the medial border of the tibia. (B) The hamstring tendon(s) of interest are harvested using the tendon stripper. The distal aspect of the autograft is then incised sharply at the pes anserinus. (C) Residual muscle is removed from the autograft using the edge of a metal ruler. (D) A running, locking no. 0 Vicryl suture is placed at each end of the graft to facilitate passage of the autograft during reconstruction. These limbs can also be passed through the native tendon with a free needle to serve as another point of graft fixation.
Figure 2.
Figure 2.
Preoperative imaging demonstrating tendinotic calcification and enthesophyte formation in a patient with advanced insertional Achilles tendinopathy.
Figure 3.
Figure 3.
Intraoperative fluoroscopy demonstrating the tunnel position for the transosseous fixation device used to dock the hamstring autograft. The regions of tendinotic calcification and the insertional enthesophyte have been resected.
Figure 4.
Figure 4.
Examples of reconstruction constructs through a 6- to 8-cm incision for treatment of subacute Achilles ruptures or chronic midsubstance tendinosis with significant tendon involvement.
Figure 5.
Figure 5.
A patient with an acute bony avulsion injury in the setting of chronic insertional tendinopathy. (A) Preoperative radiograph showing an avulsed bone fragment with a prominent posterosuperior calcaneal exostosis and an insertional enthesophyte. (B) Preoperative magnetic resonance imaging (MRI) demonstrating the templated “window” incision sites (heavy lines) and the location of the residual gap after tendon resection (double arrow). (C) The graft is docked into the calcaneus using a transosseous fixation device. (D) The graft is tunneled under the skin bridge and docked into the healthy proximal stump using a Pulvertaft weave. (E) Postoperative radiograph depicting the tunnel position for the transosseous fixation device. The prominent posterosuperior tuberosity and the insertional enthesophyte have been resected.
Figure 6.
Figure 6.
Magnetic resonance imaging scans demonstrating (A) a subacute Achilles rupture and (B) chronic midsubstance tendinosis.
Figure 7.
Figure 7.
Key steps in the treatment of a subacute Achilles rupture or chronic midsubstance tendinosis using a 3- to 4-cm incision. (A) The lateral-based skin incision is marked. (B) The diseased portion of the tendon is incised longitudinally, and unhealthy tendon is sharply excised. (C) Residual tendon gap after resection of the diseased tendon. (D) Portions of abnormal tendon that were removed. (E) Multiple hamstring autograft limbs are visible after multiple passes utilizing the Pulvertaft technique. (F) The limbs of autograft are tubularized with SutureTape to complete the reconstruction.
Figure 8.
Figure 8.
(A) Magnetic resonance imaging scan demonstrating advanced chronic insertional tendinosis and muscle atrophy requiring hamstring autograft with supplemental FHL transfer. The region between the heavy lines is the templated region of resection. (B) Infected Achilles tendon requiring extensive resection. (C) En bloc resection of diseased tendon in a patient with a subacute Achilles rupture. (D) The diseased region of tendon has been resected. The hamstring autograft is paired with an FHL tendon transfer to augment the reconstruction.
See this image and copyright information in PMC

References

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