Repair of insertional achilles tendinosis with a bone-quadriceps tendon graft.
BACKGROUND
While conservative treatment may be successful in most cases, partial rupture at the calcaneal insertion point is a significant concern with insertional Achilles tendinopathy. We report on the outcomes of a surgical technique for Achilles tendon augmentation using a bone-tendon graft harvested from the knee extensor system.


METHODS
Our retrospective case series includes 25 surgical procedures performed in 24 patients, 19 males and five females, with a mean age of 47 (range, 30 to 59) years, 18 of whom were athletes. The mean followup period was 52 (range, 12 to 156) months. All patients underwent MRI examination prior to surgery which showed partial Achilles tendon rupture. The Achilles tendon was debrided through a posterolateral approach. The bone-quadriceps tendon graft was harvested, then the bone plug of the graft was inserted into a blind tunnel drilled into the calcaneus and fixed with an interference screw. The fibers of the quadriceps tendon were sutured to the residual part of the Achilles tendon with the foot at an angle of 90 degrees.


RESULTS
Patients were able to resume their sporting activity after an average of 6.7 months. At last followup examination, physical activity was scored 5.2 on the 10-point Tegner Scale; the mean AOFAS score was 98.4. MRI examination showed good graft integration 1 year postoperatively.


CONCLUSIONS
The bone-quadriceps tendon grafting technique was a good alternative for the insertional Achilles lesions with partial detachment which we felt required augmentation.
Philippot
Rémi
R
Orthopaedic Surgery Department, Hopital Nord, Saint Etienne 42055, Cedex 2, France. r_philippot@yahoo.fr
Wegrzyn
Julien
J
Grosclaude
Sophie
S
Besse
Jean Luc
JL
D000125:Achilles Tendon / Q000473:pathology / Q000601:surgery*; D000328:Adult; D001863:Bone Screws; D002111:Calcaneus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000637:transplantation*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D052256:Tendinopathy / Q000473:pathology / Q000601:surgery*; D013710:Tendons / Q000637:transplantation*; D016896:Treatment Outcome