Neglected rupture of achilles tendon

Free masive allograft for reconstruction. Ten years follow-up

Abstract

Introduction: A neglected rupture or an inveterate Achilles tendon, with severe substance loss of the tendon itself requires specific surgical treatment in order to supply vascularization to the substance loss and in order to re-establish tendon functionality. The inveterate ruptures are characterized by the difficulty of achieving an end-to-end apposition of the tendon ends with plantar flexion of the foot during surgical reconstruction. (Abraham-Pankovich, Christiensen etc...). Objective: The Achilles tendon allograft has been used for reconstruction of neglected Achilles tendon rupture without sacrificing other autologous tendons. The use for reconstruction has been reported, but mostly limited to case report, by Nellas, Yuen and Nicholas, Lepow and Green. All the authors reported favorable outcomes after surgery because they corrected these defects satisfactorily and it allows recovering the 3 rockers of the step. Methods: The cryopreserved Achilles tendon allograft with attached bone (osteotendinous) was thawed and rehydrated in sterile normal saline solution for 30 minutes prior to insertion. During this process a quadrangular cavity of the same size as the bone block graft was carved in the posterior tuberosity of the calcaneus. Once the bone graft was hosted in the posterior tuberosity, the tendon portion was extended with 90° traction of the foot, suturing it to the calf muscles, so that it would maintain the tension of the implanted tendon. This was anchored press-fit into the carved out cavity and checked to see that it fit perfectly so as to avoid the use of osteosynthesis.This procedure has been used satisfactorily by us in two cases. Results: They have been highly favourable in the revising 10 years after surgery. The scales AOFAS (ankle scale) and OXFORD follow in the same range as the ones carried out the first year of follow-up. In case study 1, the AOFAS Clinical Rating System improved from 69 to 95 points one year after surgery and the muscle strength (OXFORD scale of 0-5) increased from 0 to 4. In case study 2, the AOFAS rating improved from 75 to 95 points and the muscle strength increased from 1 to 4. Conclusions: The use of this free allograft procedure has been recommended when significant segmental defect is encountered, about 10 cm when fascia advancement or tendon transfer is not able to provide sufficient bridging between the tendon ends. Therapeutic study: Level III.