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Surgical technique of treating neglected or iterative Achilles tendon ruptures of a hamstring graft.

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Introduction:

In patients with a rupture or iterative neglected Achilles tendon, the recommended treatment is usually surgical.
Many surgical techniques have been reported in the literature with varying functional results.

We propose a novel technique using a registry of domestic law, half tendon (hamstring) free transplant creating a transplant to 6 or 8 beams. (Fig 1)

Clinical case :

We treated three men with neglected or iterative rupture of the Achilles tendon:
- The first case was a 50 year old man with an old neglected rupture of more than a year with a tendon retraction and a tendon defect of 12 cm. (Fig 2 and 3)

- The second is a 35 year old man operated initially by percutaneous technique (T├ęnolig) with early failure and re-rupture at 6 months, with a loss of tendon substance of approximately 6 cm. (Fig 4 and 5)

- The third case is a 60 year old patient, who had a previous distal Achilles rupture operated by transosseous reintegration tendon, with early recurrent tears to 3 months require a transplant of 6 cm.

Harvesting the graft:

The surgical technique was the same for all 3 patients: removal of domestic law and of the half with a short tendon incision at the knee (Fig 6 and 7)

Preparation of the graft:

Then graft preparation in free length transplant adapted to the defect creating a good caliber graft with 6-8 beams. (Fig 8, 9 and 10)

Suturing the graft:

Then suturing the graft directly to proximal and distal tendon banks of Achilles in cases # 1 and # 2

Case 1:

old injury with a retraction and a tendon defect of 12 cm (Fig 11, 12 and 13)

Case 2:

Injury Achilles tendon defect iterative 6 cm (Fig 14 and 15)

Case 3

transosseous reintegration by anchors in the third case.

Following operative:

The postoperative need immobilization in a cast for a minimum of 2 months and gradual recovery of walking accompanied by rehabilitation. Fig 16

Re-education :

Rehabilitation is not specific, but should initially be cautious and gradual over 6 months (Fig 17 and 18)

results:

At 5 years, 2 years, 6 months follow-up functional results are satisfactory with good engraftment in 3 cases (controlled by MRI), a satisfactory functional recovery: a perimeter unlimited walking, mobility normal ankle a stable support.
In both cases a return to sport recreation was possible after the 6th month.

Conclusion:

In conclusion this original technique to cover major losses of substance of Achilles tendon with a quality graft (hamstring tendon, hamstring) free transplant, limiting the local disease grafts nearby.

Bibliographic reference :

Bosworth DM. Repair of defects in the tendo Achillis. J Bone Joint Surg 1956; 38; 111-14. 12.

Abraham E, Pankovich AM. Neglected rupture of the Achilles tendon. Treatment by VY tendinous flap. J Bone Joint Surg Am 1975; 57: 253-55.

Mann RA, Holmes GB, KS Seale, Collins DN. Chronic rupture of the Achilles tendon: a new technology of repair. J Bone Joint Surg Am 1991; 73: 214-219.

Wapner KL, Pavlock GS, Hecht PJ Naselli F Walther R. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle 1993; 14: 443-49.

Pintore E, V Barra, Pintore R, Maffulli N. peroneus brevis tendon transfer in neglected tears of the Achilles tendon. J Trauma 2001; 50: 71-78.

Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med 2002; 30: 565-75.

Maffulli N, C Tallon, Wong J, Lim KP, Bleakney R. Early weightbearing and ankle mobilization after-open repair of acute midsubstance tears of the Achilles tendon. Am J Sports Med 2003; 31: 692-700.

Kangas J, Pajala A, Siira P, M Hamalainen, Leppilahti J. Early functional treatment versus early immobilization in tension of the musculotendinous unit after-Achilles rupture repair: a prospective, randomized, clinical study. J Trauma 2003; 54: 1171-1180.

McClell D. and N. Maffulli Neglected rupture of the Achilles tendon peroneus brevis tendon reconstruction with transfer JR Coll Surg Edinb Irel, August 2, 2004, 209-213.

Doctor Nicolas LEFEVRE, Doctor Serge HERMAN. - 18 mars 2009.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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