title: Repair of chronic rupture of the achilles tendon using 2 intratendinous flaps from the proximal gastrocnemius-soleus complex.
abstract: BACKGROUND
  Chronic rupture of the Achilles tendon is a surgical challenge, owing to the presence of a gap between the retracted ends, which renders direct repair almost impossible.
  
  
  OBJECTIVE
  In this study, 2 intratendinous distally based flaps fashioned from the proximal gastrocnemiussoleus complex are used to bridge the gap between the retracted edges of the ruptured Achilles tendon. The flaps are placed in the same line of pull of the ruptured tendon, in an effort to make the graft mimic the original biomechanics as much as possible.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Eleven patients (9 male and 2 female) with neglected ruptures of the Achilles tendon with retracted ends were included in this study. Two flaps fashioned from the proximal gastrocnemiussoleus complex were rotated over themselves, passed through the proximal stump, and then securely inserted into a previously prepared bed in the distal stump.
  
  
  RESULTS
  The patients were followed up for a period of 6 to 9 years. At the final follow-up, all patients were able to return to their preinjury level of activity within a period of 6 to 9 months. The mean preoperative American Orthopedic Foot and Ankle Society score was 42.27, whereas it was 98.91 at the final follow-up, with a range of 88 (in 1 patient) to 100 points (in 10 patients). All 11 patients showed statistically significant improvement according to the Holz rating system.
  
  
  CONCLUSIONS
  This technique allows for a bridging of the defect present in chronic ruptures of Achilles tendons, with a minimum of complications and a good final outcome.
authors.affiliation: Orthopedic Department, Kasr Al Aini Teaching Hospital, Cairo University, 51B Demascus Street, Dokki, Cairo 12411, Egypt. mshewy@gmail.com
authors.forename: Mohamed Taha
authors.initials: MT
authors.lastname: El Shewy
authors.forename: Hassan Magdy
authors.initials: HM
authors.lastname: El Barbary
authors.forename: Hisham
authors.initials: H
authors.lastname: Abdel-Ghani
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation*; D012421:Rupture / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods*