title: Reconstruction for missed or neglected Achilles tendon rupture with V-Y lengthening and flexor hallucis longus tendon transfer through one incision.
abstract: BACKGROUND
  The purpose of this study was to introduce a novel operative technique and to evaluate the clinical outcomes in a cohort of patients with missed or neglected Achilles tendon ruptures.
  
  
  METHODS
  Fifteen consecutive patients with missed complete Achilles tendon ruptures and 5-cm or larger gaps had reconstruction with V-Y lengthening and flexor hallucis longus tendon transfer through a single incision. The patients were evaluated at an average of 106 weeks after surgery. At the time of followup, all patients were assessed with regard to their self-reported level of satisfaction and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Ankle strength and active range of motion were evaluated using Biodex (Biodex Medical Systems, Shirley, NY) isokinetic dynamometry. In addition, seven patients were evaluated using diagnostic ultrasound.
  
  
  RESULTS
  We found a 7.7 N-m (-22.3%) loss of plantarflexion torque at 60 degrees/sec and a 3.5 N-m (-13.5%) loss of plantarflexion torque at 120 degrees/sec, as well as a 5 degrees loss of active range of motion. AOFAS scores were all good to excellent, with an average score of 94.1 of 100. All patients were satisfied with their outcomes (rated good or very good). Excellent exposure of the Achilles tendon repair was obtained with ultrasound.
  
  
  CONCLUSIONS
  For patients with missed or neglected Achilles tendon rupture with a rupture gap of at least 5 cm, operative repair using V-Y lengthening and flexor hallucis longus tendon transfer through a single incision technique achieved a high percentage of satisfactory results.
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
authors.forename: Ilan
authors.initials: I
authors.lastname: Elias
authors.forename: Marcus
authors.initials: M
authors.lastname: Besser
authors.forename: Levon N
authors.initials: LN
authors.lastname: Nazarian
authors.forename: Steven M
authors.initials: SM
authors.lastname: Raikin
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012421:Rupture; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013536:Suture Techniques; D013709:Tendon Transfer / Q000145:classification / Q000379:methods*; D019415:Torque; D016896:Treatment Outcome; D014463:Ultrasonography