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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)
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.
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)
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)
Then suturing the graft directly to proximal and distal tendon banks of Achilles in cases # 1 and # 2
old injury with a retraction and a tendon defect of 12 cm (Fig 11, 12 and 13)
Injury Achilles tendon defect iterative 6 cm (Fig 14 and 15)
transosseous reintegration by anchors in the third case.
The postoperative need immobilization in a cast for a minimum of 2 months and gradual recovery of walking accompanied by rehabilitation. Fig 16
Rehabilitation is not specific, but should initially be cautious and gradual over 6 months (Fig 17 and 18)
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.
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.
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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.
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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.
This technique of reconstruction of the anterior cruciate ligament plasty involving extra and intra-articular fascia lata was described by Hey-Groves in 1917, modified in 1972 and MacIntosh Jaeger recently. This reconstruction is a technique increasingly practiced for controlling the tibial rotation and rotational jump experienced by the patient and the surgeon objectified by clinical examination.
This lateral grafting used in this technique is called the fascia lata is a transplant with high resistance comparable to other biomechanical transplants used. The fascia lata retains its tibial insertion, which is a natural attachment system and therefore superior to any other system used. This technique has the advantages of not having to levy tendon and therefore the hope of postoperative muscle recovery and normalization of the fastest isokinetic tests.
The coracoid bone block screwed in front of the glenoid realized today either open or arthroscopically.
The advantages of arthroscopic abutment technique are:
- Take stock of the damage to the joint, bead, cartilage, loss of bone substance, tendon injuries
- The precise positioning of the stop because under direct control by the camera,
- Of smaller sizes scars,
- The treatment of lesions as lesions of the biceps (SLAP lesion) or lesions of the rotator cuff (tendon rupture) that can be treated in the same operation
- Early functional recovery
Latarjet arthroscopic intervention
The procedure is most often performed under general anesthesia with an inter-scalene block made ??preoperatively by the anesthetist. It involves taking a bone block of about 2 cm at the expense of the coracoid and place it in the anterior and inferior part of the glenoid cavity, passing through the subscapularis muscle. The coracoid can be positioned upright and secured by a screw according to Bristow or lying and fixed by two screws according Latarjet. (read more..)
The shoulder dislocations and recurrent anterior instability is a common problem among young athletes making up 90% of shoulder dislocations. Surgical indication can be provided in these cases of glenohumeral dislocations previous recurrent, but also in cases of painful and unstable shoulders. A question now arises, should we offer it immediately after the first dislocation or should we expect one or more recurrences? (Read more ...)
Patient, 58, sporting good level with chronic tendinitis of the Achilles tendon of the left.
chronic Achilles tendon pain lasting for more than a year after a triathlon.
The patient has received medical treatment (necessary before any surgical decision): rehabilitation, Stanish stretching, shock wave, orthopedic soles. (read more...)
While muscle injuries of the posterior region of the thigh are common in athletes, the proximal hamstring rupture is a rare disease. A study published in 2003  analyzed in a consecutive series of 170 patients, 179 trauma hamstrings occurred over a period of 3 years. MRI and / or ultrasound showed that only 12% of the injuries were fractures of the proximal and 9% complete ruptures. It is also little known, the first cases described in the literature from 1988 . Clinically the patients describe a violent pain in the buttock (stab printing) followed by leg weakness. ( To be continued..)