title: Less-invasive reconstruction of chronic achilles tendon ruptures using a peroneus brevis tendon transfer.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England. n.maffulli@qmul.ac.uk
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Filippo
authors.initials: F
authors.lastname: Spiezia
authors.forename: Umile Giuseppe
authors.initials: UG
authors.lastname: Longo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000328:Adult; D001265:Athletic Injuries / Q000175:diagnosis / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D008297:Male; D008875:Middle Aged; D056948:Orthognathic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D018709:Statistics, Nonparametric; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome