Background: A less-invasive technique to reconstruct chronic Achilles tendon rupture with transfer of the tendon of peroneus brevis is suitable in patients with a tendon gap less than 6 cm.
Purpose: To report the results of a longitudinal study on reconstruction of chronic Achilles tendon rupture using a less-invasive peroneus brevis repair through 2 paramidline incisions.
Study Design: Case series; Level of evidence, 4.
Methods: Thirty-two patients underwent surgery for chronic Achilles tendon rupture with a tendon gap during surgery less than 6 cm, occurring between 60 days and 9 months preoperatively. All participants were prospectively followed for 5 to 8 years; final review was performed at 48.4 ± 13.5 months from the operation. Clinical and functional assessment (anthropometric measurements, isometric strength, postoperative Achilles tendon total rupture score) was performed.
Results: All patients were able to walk on tiptoes, and no patient used a heel lift or walked with a visible limp. No patient developed a clinically evident deep vein thrombosis or sustained a rerupture. Five patients were managed nonoperatively after a superficial infection of one of the surgical wounds. At final review, the maximum calf circumference remained significantly decreased in the operated leg (39.2 ± 6.2 cm [side with rupture] vs 40.9 ± 7.0 cm [uninjured side]; P = .04). The operated limb was significantly less strong than the nonoperated one (231.2 ± 132.4 N vs 275.3 ± 150.2 N; P = .033). The Achilles tendon total rupture score at final follow-up was 92.5 ± 14.2.
Conclusion: The management of chronic Achilles tendon tears by a less-invasive peroneus brevis repair is technically demanding but safe. It allows good recovery, even in patients with a chronic rupture of 9 months’ duration. These patients should be warned that they are at risk for postoperative complications and that their ankle plantar flexion strength is likely to be reduced.
AbrahamEPankovichAM. Neglected rupture of the Achilles tendon: treatment by V-Y tendinous flap. J Bone Joint Surg Am. 1975;57(2):253-255.
2.
BleakneyRRTallonCWongJKLimKPMaffulliN. Long-term ultrasonographic features of the Achilles tendon after rupture. Clin J Sport Med. 2002;12(5):273-278.
3.
BosworthDM. Repair of defects in the tendo Achillis. J Bone Joint Surg Am. 1956;38(1):111-114.
4.
BoydenEMKitaokaHBCahalanTDAnKN. Late versus early repair of Achilles tendon rupture: clinical and biomechanical evaluation. Clin Orthop Relat Res. 1995;317:150-158.
5.
CarmontMRMaffulliN. Less invasive Achilles tendon reconstruction. BMC Musculoskelet Disord. 2007;8:100.
6.
ChanKMMaffulliN. Principles and Practice of Isokinetics in Sports Medicine and Rehabilitation. Hong Kong: Williams & Wilkins Asia-Pacific Ltd; 1996.
7.
ChristensenI. Rupture of the Achilles tendon: analysis of 57 cases. Acta Chir Scand. 1953;106(1):50-60.
CottomJMHyerCFBerletGCLeeTH. Flexor hallucis tendon transfer with an interference screw for chronic Achilles tendinosis: a report of 62 cases. Foot Ankle Spec. 2008;1(5):280-287.
DalalRBZeniosM. The flexor hallucis longus tendon transfer for chronic tendo-Achilles ruptures revisited. Ann R Coll Surg Engl. 2003;85(4):283.
12.
DeCarboWTHyerCF. Interference screw fixation for flexor hallucis longus tendon transfer for chronic Achilles tendinopathy. J Foot Ankle Surg. 2008;47(1):69-72.
13.
EbinesanADSaraiBSWalleyGDMaffulliN. Conservative, open or percutaneous repair for acute rupture of the Achilles tendon. Disabil Rehabil. 2008;30(20-22):1721-1725.
14.
FerrisLSharkeyNASmithTSMatthewsDK. Influence of extrinsic plantar flexors on forefoot loading during heel rise. Foot Ankle Int. 1995;16(8):464-473.
15.
GallantGGMassieCTurcoVJ. Assessment of eversion and plantar flexion strength after repair of Achilles tendon rupture using peroneus brevis tendon transfer. Am J Orthop (Belle Mead NJ). 1995;24(3):257-261.
16.
HahnFMaiwaldCHorstmannTVienneP. Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus transfer. Clin Biomech (Bristol, Avon). 2008;23(1):109-116.
17.
IncavoSJAlvarezRGTrevinoSG. Occurrence of the plantaris tendon in patients sustaining subcutaneous rupture of the Achilles tendon. Foot Ankle. 1987;8(2):110-111.
18.
JacobHA. Forces acting in the forefoot during normal gait: an estimate. Clin Biomech (Bristol, Avon). 2001;16(9):783-792.
19.
KarousouERongaMVigettiDPassiAMaffulliN. Collagens, proteoglycans, MMP-2, MMP-9 and TIMPs in human Achilles tendon rupture. Clin Orthop Relat Res. 2008;466(7):1577-1582.
20.
KumtaSMMaffulliN. Local flap coverage for soft tissue defects following open repair of Achilles tendon rupture. Acta Orthop Belg. 2003;69(1):59-66.
21.
KuwadaGT. Classification of tendo Achillis rupture with consideration of surgical repair techniques. J Foot Surg. 1990;29(4):361-365.
22.
KuwadaGT. Critical analysis of tendo Achillis repair using Achilles tendon rupture classification system and repair. J Foot Ankle Surg. 1993;32(6):611-616.
23.
LeitnerAVoigtCRahmanzadehR. Treatment of extensive aseptic defects in old Achilles tendon ruptures: methods and case reports. Foot Ankle. 1992;13(4):176-180.
LongoUGRongaMMaffulliN. Achilles tendinopathy. Sports Med Arthrosc. 2009;17(2):112-126.
26.
LongoUGRongaMMaffulliN. Acute ruptures of the Achilles tendon. Sports Med Arthrosc. 2009;17(2):127-138.
27.
LynnTA. Repair of the torn Achilles tendon, using the plantaris tendon as a reinforcing membrane. J Bone Joint Surg Am. 1966;48(2):268-272.
28.
MaffulliN. Clinical tests in sports medicine: more on Achilles tendon. Br J Sports Med. 1996;30(3):250.
29.
MaffulliN. The clinical diagnosis of subcutaneous tear of the Achilles tendon: a prospective study in 174 patients. Am J Sports Med. 1998;26(2):266-270.
30.
MaffulliN. Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81(7):1019-1036.
31.
MaffulliNAjisALongoUGDenaroV. Chronic rupture of tendo Achillis. Foot Ankle Clin. 2007;12(4):583-596.
32.
MaffulliNDymondNPCapassoG. Ultrasonographic findings in subcutaneous rupture of Achilles tendon. J Sports Med Phys Fitness. 1989;29(4):365-368.
33.
MaffulliNDymondNPRegineR. Surgical repair of ruptured Achilles tendon in sportsmen and sedentary patients: a longitudinal ultrasound assessment. Int J Sports Med. 1990;11(1):78-84.
34.
MaffulliNLeadbetterWB. Free gracilis tendon graft in neglected tears of the Achilles tendon. Clin J Sport Med. 2005;15(2):56-61.
35.
MaffulliNLongoUGGougouliasNDenaroV. Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon. BMC Musculoskelet Disord. 2008;9:100.
36.
MaffulliNLongoUGRongaMKhannaADenaroV. Favorable outcome of percutaneous repair of Achilles tendon ruptures in the elderly. Clin Orthop Relat Res. 2010;468:1039-1046.
37.
MaffulliNLongoUGSpieziaFDenaroV. Free hamstrings tendon transfer and interference screw fixation for less invasive reconstruction of chronic avulsions of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2010;18:269-273.
38.
MaffulliNTallonCWongJLimKPBleakneyR. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the Achilles tendon. Am J Sports Med. 2003;31(5):692-700.
39.
MaffulliNTallonCWongJPeng LimKBleakneyR. No adverse effect of early weight bearing following open repair of acute tears of the Achilles tendon. J Sports Med Phys Fitness. 2003;43(3):367-379.
40.
MaffulliNWaterstonSWSquairJReaperJDouglasAS. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med. 1999;9(3):157-160.
41.
MahajanRHDalalRB. Flexor hallucis longus tendon transfer for reconstruction of chronically ruptured Achilles tendons. J Orthop Surg (Hong Kong). 2009;17(2):194-198.
42.
MatlesAL. Rupture of the tendo Achilles: another diagnostic sign. Bull Hosp Joint Dis. 1975;36(1):48-51.
43.
McClellandDMaffulliN. Percutaneous repair of ruptured Achilles tendon. J R Coll Surg Edinb. 2002;47(4):613-618.
44.
McClellandDMaffulliN. Neglected rupture of the Achilles tendon: reconstruction with peroneus brevis tendon transfer. Surgeon. 2004;2(4):209-213.
Nilsson-HelanderKSwardLSilbernagelKGThomeeRErikssonBIKarlssonJ. A new surgical method to treat chronic ruptures and reruptures of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2008;16(6):614-620.
47.
Nilsson-HelanderKThomeeRGravare-SilbernagelK. The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med. 2007;35(3):421-426.
48.
Nilsson-HelanderKThurinAKarlssonJErikssonBI. High incidence of deep venous thrombosis after Achilles tendon rupture: a prospective study. Knee Surg Sports Traumatol Arthrosc. 2009;17(10):1234-1238.
49.
Perez TeufferA. Traumatic rupture of the Achilles tendon: reconstruction by transplant and graft using the lateral peroneus brevis. Orthop Clin North Am. 1974;5:89-93.
50.
PintoreEBarraVPintoreRMaffulliN. Peroneus brevis tendon transfer in neglected tears of the Achilles tendon. J Trauma. 2001;50(1):71-78.
51.
RichardsonDRWillersJCohenBEDavisWHJonesCPAndersonRB. Evaluation of the hallux morbidity of single-incision flexor hallucis longus tendon transfer. Foot Ankle Int. 2009;30(7):627-630.
52.
SebastianHDattaBMaffulliNNeilMWalshWR. Mechanical properties of reconstructed Achilles tendon with transfer of peroneus brevis or flexor hallucis longus tendon. J Foot Ankle Surg. 2007;46(6):424-428.
53.
SimmondsFA. The diagnosis of the ruptured Achilles tendon. Practitioner. 1957;179(1069):56-58.
54.
SuttinarkPSuebpongsiriP. Clinical outcomes of flexor hallucis longus transfer for the treatment of Achilles tendinosis rupture. J Med Assoc Thai. 2009;92(suppl 6):S226-231.
55.
TallonCMaffulliNEwenSW. Ruptured Achilles tendons are significantly more degenerated than tendinopathic tendons. Med Sci Sports Exerc. 2001;33(12):1983-1990.
56.
TrillatAJouvinrouxPMarsanCBremantJJ. Treatment of former rupture of the Achilles tendon (transfer-plasty of the lateral peroneus brevis) [in French]. Lyon Chir. 1967;63(4):603-606.
