Contact us

Make an appointment

our specialists


  01 40 79 40 36






Sports Clinic

36 bd St Marcel

75005 PARIS

Sports clinic Paris

Metro: Saint Marcel

Parking 6 rue test


'Pages chirurgiedusport :


Ce site respecte les principes de la charte HONcode de HON Ce site respecte les principes de la charte HONcode.
Site certifié en partenariat avec la Haute Autorité de Santé (HAS).
Check here


Youtube video

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

Print Article


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 (Ténolig) 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)


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.

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.


Read also ...

The most read articles

Technical cruciate ligament

By Dr. Nicolas Lefevre

More videos

Last publications

Feature: knee prosthesis

total knee replacement

Feature: knee ligaments

Dossier: Ambulatory Surgery ACL

Dossier: meniscus


Feature: Shoulder sportsman

Folder: hip prosthesis

Dossier: break hamstring

Dr. Lefevre proximal anatomie_ischio_jambier_rupture chirurgiedusport

Dossier: prosthetic and sports

hip replacement and knee and sports

Dossier: PRP

Chirurgiedusport - Who are we - Contact us - Legal Notice - Web design Digitaline - EMC2 Studio development - Clinique du Sport
Prendre rendez-vous en ligneDoctolib