title: Ankle morbidity after autogenous Achilles tendon harvesting for anterior cruciate ligament reconstruction.
abstract: Although several alternative autografts with reduced morbidity of harvest site have been introduced, no donor site is free of morbidity concerns. The authors report on ankle status after autogenous Achilles tendon harvesting with a minimum 10-year follow-up. From October 1994 to October 1996, a consecutive series of 47 ankles underwent harvesting of the medial third or half of the ipsilateral autogenous Achilles tendon for primary anterior cruciate ligament reconstruction. Donor site statuses were evaluated using a modified Thermann's scale. Postoperative isokinetic muscle strength testing was performed, and magnetic resonance images of donor sites were available for selected patients. Thirty-three ankles in the 32 patients were followed for more than 10 years. There were 27 men (84%) and 5 women (16%) with a mean age of 31 years (range 16-52 years) at the time of surgery. The mean duration of follow-up was 12 years and 1 month (range 10 years and 5 months to 13 years and 4 months). Mean postoperative modified Thermann's scale score was 87 (range 45-95; SD 14.3). Twenty-five (76%) ankles achieved very good or good results. A slight decrease in calf circumference <1 cm was seen in the ten ankles, 1-2 cm in the four ankles. Nine ankles were mildly hypersensitive to meteorological changes. Peak torque of ankle plantar flexion was slightly lower on the index limb at both velocities in nine selected patients who carried out performance tests. However, there were no significant differences (5.2% at 30 degrees /s and 2.7% at 120 degrees /s, P = n.s. and P = n.s.). Of the 12 available follow-up magnetic resonance images, the average cross-sectional area of the remaining tendon was 82.01 mm(2) (range 69.05-107.35; SD 10.3), and their average thickness was 7.4 mm (range 6-10.35; SD 1.1). After a minimum 10-year follow-up, the harvesting of autogenous Achilles tendons was not found to significantly jeopardize ankle status. However, it also could not be independent of donor morbidity as an alternative. The level of evidence was retrospective level IV, as a therapeutic study.
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, Korea.
authors.forename: Jai Gon
authors.initials: JG
authors.lastname: Seo
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Yoo
authors.forename: Young Wan
authors.initials: YW
authors.lastname: Moon
authors.forename: Moon Jong
authors.initials: MJ
authors.lastname: Chang
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Kwon
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Mu Hyun
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000125:Achilles Tendon / Q000473:pathology / Q000637:transplantation*; D000293:Adolescent; D000328:Adult; D000842:Ankle / Q000473:pathology* / Q000503:physiopathology; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D050376:Bone-Patellar Tendon-Bone Grafting / Q000009:adverse effects* / Q000379:methods / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D014182:Transplantation, Autologous; D055815:Young Adult