Achilles Tendon Reconstruction with Semitendinous Tendon Grafts Is Associated with a High Complication Rate

2020 ◽  
Vol 110 (2) ◽  
Author(s):  
Antti J. Stenroos ◽  
Tuomas Brinck
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Deep Infection ◽  
Tendon Graft ◽  
University Hospital ◽  
Flexor Hallucis Longus ◽  
Augmentation Techniques ◽  
Tendon Ruptures ◽  
Tendon Grafts ◽  
Semitendinous Tendon

Background In the presence of a large gap where end-to-end repair of the torn Achilles tendon is difficult and V-Y advancement would likely be insufficient, augmentation is sometimes required. At our institute we have used primarily the hamstring autograft augmentation technique for the past two decades. The aim of this study was to analyze the complications after surgical treatment of Achilles tendon rupture with semitendinous tendon augmentation. Methods We retrospectively analyzed 58 consecutive patients treated with semitendinous tendon autograft augmentation at the Helsinki University Hospital between January 1, 2006, and January 1, 2016. Results During the study period, 58 patients were operated on by six different surgeons. Of 14 observed complications (24%), seven were major and seven were minor. Most of the complications were infections (n = 10 [71%]) The infections were noted within a mean of 62 days postoperatively (range, 22–180 days). Seven patients with a complication underwent repeated operation because of skin edge necrosis and deep infection (five patients), hematoma formation (one patient), and a repeated rupture (one patient). Conclusions In light of the experience we have had with autologous semitendinous tendon graft augmentation, we cannot recommend this technique, and, hence, we should abandon reconstruction of Achilles tendon ruptures with autologous semitendinous tendon grafts at our institute. Instead, other augmentation techniques, such as flexor hallucis longus tendon transfer, should be used.

Repair of Chronic Achilles Ruptures Has a High Incidence of Venous Thromboembolism

2016 ◽  
Vol 10 (5) ◽  
pp. 415-420 ◽  
Author(s):  
Mark J. Bullock ◽  
William T. DeCarbo ◽  
Mark H. Hofbauer ◽  
Joshua D. Thun
Keyword(s):  
Venous Thromboembolism ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Achilles Tendon Repair ◽  
Elective Repair ◽  
High Incidence ◽  
Tendon Ruptures

Background. Despite the low incidence of deep vein thrombosis (DVT) in foot and ankle surgery, some authors report a high incidence of symptomatic DVT following Achilles tendon rupture. The purpose of this study was to identify DVT risk factors inherent to Achilles tendon repair to determine which patients may benefit from prophylaxis. Methods. One hundred and thirteen patient charts were reviewed following elective and nonelective Achilles tendon repair. For elective repair of insertional or noninsertional Achilles tendinopathy, parameters examined included lateral versus prone positioning and the presence versus absence of a flexor hallucis longus transfer. For nonelective repair, acute Achilles tendon ruptures were compared to chronic Achilles tendon ruptures. Results. Of 113 Achilles tendon repairs, 3 venous thromboembolism (VTE) events (2.65%) occurred including 2 pulmonary emboli (1.77%). Seventeen of these repairs were chronic Achilles tendon ruptures, and all 3 VTE events (17.6%) occurred within this subgroup. Elevated body mass index was associated with VTE in patients with chronic Achilles ruptures although this did not reach significance ( P = .064). No VTE events were reported after repair of 28 acute tendon ruptures or after 68 elective repairs of tendinopathy. Two patients with misdiagnosed partial Achilles tendon tears were excluded because they experienced a VTE event 3 weeks and 5 weeks after injury, prior to surgery. Conclusion. In our retrospective review, chronic Achilles ruptures had a statistically significant higher incidence of VTE compared with acute Achilles ruptures ( P = .048) or elective repair ( P = .0069). Pharmaceutical anticoagulation may be considered for repair of chronic ruptures. Repair of acute ruptures and elective repair may not warrant routine prophylaxis due to a lower incidence of VTE. Levels of Evidence: Prognostic, Level III: Case Control Study

Acute Achilles Tendon Rupture in Badminton Players

1998 ◽  
Vol 26 (3) ◽  
pp. 467-470 ◽  
Author(s):  
Martin Fahlström ◽  
Ulf Björnstig ◽  
Ronny Lorentzon
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Specific Treatment ◽  
Treated Group ◽  
Activity Level ◽  
University Hospital ◽  
Long Term Results ◽  
Postoperative Rehabilitation ◽  
Sports Activity ◽  
Tendon Ruptures

All patients with badminton-related acute Achilles tendon ruptures registered during 1990 to 1994 at the University Hospital of Umeå were retrospectively followed up using a questionnaire. Thirty-one patients (mean age, 36.0 years), 27 men and 4 women, were included. Thirty patients (97%) described themselves as recreational players or beginners. The majority of the injuries (29 of 31, 94%) happened at the middle or end of the planned game. Previous local symptoms had been noticed by five patients (16%). Long-term results showed that patients treated with surgery had a significantly shorter sick leave absence than patients treated without surgery (50 versus 75 days). There was no obvious selection favoring any treatment modality. None of the surgically treated patients had reruptures, but two reruptures occurred in the nonsurgically treated group. There seemed to be fewer remaining symptoms and a higher sports activity level after the injury in the surgically treated group. Our results indicate that local muscle fatigue may interfere with strength and coordination. Preventive measures such as specific treatment of minor injuries and adequate training of strength, endurance, and coordination are important. Our findings also indicate that surgical treatment and careful postoperative rehabilitation is of great importance among badminton players of any age or sports level with Achilles tendon ruptures.

scholarly journals Flexor hallucis longus vs. peroneus brevis: the better tendon for augmentation surgery in chronic achilles tendon ruptures

2019 ◽  
Vol 5 (2) ◽  
pp. 264 ◽  
Author(s):  
K. V. Nagakiran ◽  
Sudeep Madhukar Nambiar ◽  
Prasad Soraganvi ◽  
Sameer Wooly ◽  
H. Balakrishna Gadiyar
Keyword(s):  
Achilles Tendon ◽  
Functional Outcome ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Flexor Hallucis Longus ◽  
Proximal Migration ◽  
Calcific Tendonitis ◽  
Tendon Ruptures ◽  
Peroneus Brevis

<p class="abstract"><strong>Background:</strong> Chronic degenerative Achilles tendon ruptures are increasing in incidence. Calcific tendonitis, poor vascularity, prior steroid injections, and proximal migration of tendon render conservative management ineffective. Flexor hallucis longus (FHL) and peroneus brevis (PB) have shown promising results with tendon augmentation procedures. The study was done to find out which was a better tendon for augmentation among the two.</p><p class="abstract"><strong>Methods:</strong> A total of 27 patients underwent tendon augmentation surgeries using FHL (n=14) and PB (n=13) after randomization at PES Institute of medical sciences and research, Kuppam from March 2014 to December 2018. Both the groups had a standard postoperative regimen and rehabilitative protocol. Functional outcome was assessed using AOFAS, Leppilahti score and ATRS scores.<strong></strong></p><p class="abstract"><strong>Results:</strong> The functional outcome was comparable in both FHL and PB and there was no clear winner in the study.</p><p class="abstract"><strong>Conclusions:</strong> Predictably<strong> </strong>good results are seen with tendon augmentation procedures for Achilles tendon rupture. Both FHL and PB are equally good in providing good plantar flexion power needed in achilles tendon rupture.</p>

Dual Purpose Use of Flexor Hallucis Longus Tendon for Management of Chronic Achilles Tendon Ruptures

2018 ◽  
Vol 12 (4) ◽  
pp. 345-349
Author(s):  
Mohammed A. Khalid ◽  
William M. Weiss ◽  
Michael Iloanya ◽  
Vinod K. Panchbhavi
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Invasive Technique ◽  
Flexor Hallucis Longus ◽  
Aofas Score ◽  
Excellent Outcome ◽  
Longus Tendon ◽  
Tendon Ruptures

Background: Chronic Achilles tendon ruptures are uncommon and increase long-term morbidity when untreated. There is no standard treatment for this condition. Methods: Chronic Achilles tendon rupture was repaired in 10 patients by harvesting the flexor hallucis longus tendon (FHL) using a minimally invasive technique. It was then transferred to the calcaneus and the remnant used to bridge the gap for reconstructing the Achilles tendon itself. The patients were assessed using the American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot Scale. Results: Patients were evaluated postoperatively to assess pain, function, and alignment of the ankle and hindfoot. Average follow-up time was 30.9 months (range = 17-43 months). The average postoperative AOFAS score was 78.5 (range = 54-94). The average postoperative score for pain was 33.5 out of 40; for function, 38.7 out of 50; and for alignment, 6.3 out of 10. A single surgical site infection requiring Incision and Drainage (I&D) was the only operative complication noted. No patient developed a significant deformity of the hallux after transfer. Conclusions: FHL transfer using a minimally invasive harvest for the treatment of chronic Achilles tendon ruptures produces good to excellent outcome measures as judged by an AOFAS score of 75 or greater while minimizing risk to the medial neurovascular bundle. Levels of Evidence: Case series, Level IV: Retrospective

scholarly journals Short-term Outcomes of Open “Crown” Type v. Percutaneous Bunnell Type Repair of Acute Achilles Tendon Ruptures. Randomized Control Study

2020 ◽  
Vol 19 (3-4) ◽  
pp. 101-108
Author(s):  
Aleksas Makulavičius ◽  
Giedrius Mazarevičius ◽  
Povilas Masionis ◽  
Matas Urmanavičius ◽  
Mindaugas Klinga ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Achilles Tendon ◽  
Controlled Trial ◽  
Achilles Tendon Rupture ◽  
Deep Infection ◽  
Percutaneous Technique ◽  
Absorbable Suture ◽  
Significant Difference ◽  
Tendon Ruptures ◽  
Group B

Background. The optimal treatment of acute Achilles tendon ruptures is still under debate. The purpose of this randomized controlled trial was to evaluate outcomes of open repair comparing with percutaneous procedure for Achilles tendon ruptures. Methods. 100 patients with acute Achilles tendon rupture were randomized in two groups: open “crown” type (group A) and percutaneous Bunnell type repair (group B). Absorbable suture was used in both groups. 87 patients were available for the mean follow up of 6 months. Results. No statistically significant difference was observed between groups in ATRS (Achilles Tendon Total Rupture Score), leg circumference, single heel rise, Achilles resting angle, time back to work and sports and overall patient satisfaction. Percutaneous technique was much faster. Overall 13 complications occurred in both groups (5 and 8 respectively). No deep infection occurred, no revisions were needed. Conclusions. Both techniques showed to be effective and safe when using absorbable suture material with a high patient satisfaction and a low complication rate, but percutaneous repair was significantly faster.

Endoscopic Flexor Hallucis Longus Transfer for Chronic Noninsertional Achilles Tendon Rupture

2018 ◽  
Vol 39 (12) ◽  
pp. 1464-1472 ◽  
Author(s):  
Jordi Vega ◽  
Jesus Vilá ◽  
Jorge Batista ◽  
Francesc Malagelada ◽  
Miki Dalmau-Pastor
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Flexor Hallucis Longus ◽  
Level Of Evidence ◽  
Wound Breakdown ◽  
Tendon Ruptures

Background: Operative management of chronic Achilles tendon ruptures is challenging, and numerous techniques have been described. Risk of infection and wound breakdown have been described after open techniques, and minimally invasive methods have been proposed to avoid them. The aim of this study was to describe the clinical and radiological results obtained after endoscopic flexor hallucis longus (FHL) tendon transfer in patients with chronic Achilles tendon rupture. Methods: Between 2012 and 2015, a total of 22 patients were endoscopically treated for chronic Achilles tendon rupture. Mean age was 69 years (range, 59-84 years). Mean follow-up was 30.5 months (range, 18-46 months). Preoperative magnetic resonance imaging (MRI) was obtained and tendon gap measured. An MRI was obtained at 9 to 12 months following surgery to evaluate Achilles tendon changes. Results: Preoperative MRI examination showed a mean tendon gap of 6.3 cm (range, 3-10.7 cm). The MRI control was obtained only in 12 patients, and a normal or close to normal Achilles tendon was observed in all but 1 patient. The mean American Orthopaedic Foot & Ankle Society score increased from 55 preoperatively (range, 26-75) to 91 (range, 74-100) at final follow-up. All patients returned to their daily activities without difficulties. No patients reported complaints or symptomatic deficits of great toe flexion strength. No major complications were encountered. Conclusion: Chronic Achilles tendon ruptures were successfully treated by an all-endoscopic procedure. The endoscopically assisted FHL transfer provided excellent results while benefiting from the minimally invasive procedure advantages. However, it entailed some technical challenges and may not be suitable for less experienced surgeons. Level of Evidence: Level IV, retrospective case series.

scholarly journals The Influence of Diabetes on Acute Achilles Tendon Rupture Repair

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0028
Author(s):  
Jonathan Kaplan ◽  
Jeffery Hillam ◽  
Amiethab Aiyer ◽  
Niall Smyth
Keyword(s):  
Diabetes Mellitus ◽  
Postoperative Complications ◽  
Achilles Tendon ◽  
Power Analysis ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Achilles Tendon Rupture ◽  
The United States ◽  
Foot And Ankle ◽  
Tendon Ruptures

Category: Sports Introduction/Purpose: Diabetes Mellitus (DM) is an epidemic affecting millions of individuals in the United States. Multiple studies have demonstrated an increase in complications in foot and ankle surgery in patients with DM, including wound healing complications, surgical site infections (SSI), or surgical failure. The goal of this study was to retrospectively review outcomes data from the National Surgical Quality Improvement Program (NSQIP) to determine the impact of DM on operative treatment of achilles tendon ruptures. Methods: Using the NSQIP from 2006-2015, patients were identified using common procedure terminology (CPT) for Achilles tendon ruptures. Diabetic and non-diabetic cohorts were evaluated to compare demographics, comorbidities, perioperative details and 30-day outcomes. Statistical evaluation included a power analysis for the primary outcome measure of wound disruption as well as univariate analysis was performed using chi-squared or Fisher’s exact and Wilcoxon signed-rank tests. Results: A total of 2,014 patients were identified having sustained an Achilles tendon rupture. There were 1,981 patients without DM and 33 patients with DM. There were no significant differences in postoperative complications, including SSI, medical complications, and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures. The power analysis for wound disruption showed a P=0.9 with an alpha of 0.05, sample size of n=2014, and Pearson correlation coefficient of r=0.0721 Conclusion: While DM has been shown to have an increase in complications in various foot and ankle procedures, this study demonstrates that there is no significant difference in postoperative complications and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures using the NSQIP database from 2006-2015. Based on this data, patients with diabetes mellitus can be considered adequate surgical candidates for acute Achilles tendon rupture repair.

scholarly journals Early Postoperative Results of Endoscopic Transfer of Flexor Hallucis Longus for Chronic Achilles Rupture

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Daniel Baumfeld ◽  
Fernando Raduan ◽  
Caio Nery ◽  
Benjamim Macedo ◽  
Thiago Silva ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Invasive Technique ◽  
Flexor Hallucis Longus ◽  
Open Procedure ◽  
Wound Healing Problems ◽  
Major Increase ◽  
Chronic Injuries

Category: Ankle, Arthroscopy, Hindfoot Introduction/Purpose: Background Achilles tendon chronic rupture lead to proximal retraction of the tendon and have a greater tendency to show poorer functional outcomes than acute ruptures. Numerous surgical procedures have been described to treat this pathology. The transfer of the flexor hallucis longus is a well-established treatment option, usually performed as an open procedure. The aim of this paper is to report a case series of six patients with chronic Achilles tendon rupture treated with endoscopic transfer of FHL. Methods: Six patients with Achilles tendon chronic injuries or re-ruptures were treated with endoscopic FHL transfer. There were four man and two women, average of 50 years, with four left and two right tendons involved, and no bilateral cases. All lesions were at zone 2 (between 2-6 cm proximal to insertion). We describe the surgical technique and report our results at an average of a nine-month follow-up. Results: The average follow-up of the series was 9 months (range, 5–12 months). Three patients had an associate procedure at the Achilles tendon to repair the pre-existent gap, using a minimally invasive technique. On average, we expend 56 minutes to perform the surgery, ranging from 45 to 70 minutes. All patients had a major increase in ATRS score values postoperatively, with an average of 17.8 preoperatively and 83,3 postoperatively No major complications or wound healing problems were noted. Tiptoe stance was possible for all patients without limitation. None of the patients noticed functional weakness of the hallux during daily life activity. Conclusion: Endoscopic FLH transfer is a reliable option for patients with higher skin risk and soft tissue complications. Other studies are needed to compare this technique with the open procedure, gold standard by now, to ensure its safety and efficacy.

scholarly journals Flexor hallucis longus tendon transfer for chronic Achilles tendon rupture. A retrospective study

2019 ◽  
Vol 25 (5) ◽  
pp. 630-635 ◽  
Author(s):  
Ole Kristian Alhaug ◽  
Gøran Berdal ◽  
Elisabeth Ellingsen Husebye ◽  
Kjetil Hvaal
Keyword(s):  
Retrospective Study ◽  
Achilles Tendon ◽  
Tendon Transfer ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Flexor Hallucis Longus ◽  
Longus Tendon
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