title: Free gracilis tendon graft for reconstruction of chronic tears of the Achilles tendon.
abstract: BACKGROUND
  Chronic tears of the Achilles tendon with a tendon gap exceeding 6 cm are a surgical challenge. The purpose of this study is to report the long-term results of reconstruction of such chronic Achilles tendon ruptures with use of a free autologous gracilis tendon graft.
  
  
  METHODS
  Twenty-one patients underwent reconstruction of a chronic rupture of the Achilles tendon. Fifteen patients were available for clinical and functional assessment on the basis of anthropometric measurements, isometric strength testing, and the Achilles Tendon Total Rupture Score after a mean duration of follow-up of 10.9 years (range, eight to twelve years).
  
  
  RESULTS
  All fifteen patients were able to walk on the tiptoes, and no patient used a heel lift or walked with a visible limp. At an average of 10.9 years of follow-up, the maximum calf circumference of the operatively treated leg remained substantially decreased and the operatively treated limb was significantly weaker than the contralateral, normal limb. Two patients had developed tendinopathy of the contralateral Achilles tendon, one had developed tendinopathy of the reconstructed tendon, and one had ruptured the contralateral Achilles tendon eight years after the index tear.
  
  
  CONCLUSIONS
  The long-term results of treatment of chronic tears of the Achilles tendon with free gracilis tendon grafting showed that patients retained good functional results despite permanently impaired ankle plantar flexion strength and decreased calf circumference.
authors.affiliation: Centre for Sports and Exercise Medicine, 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: Vittorino
authors.initials: V
authors.lastname: Testa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capasso
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; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D010147:Pain Measurement; D019651:Plastic Surgery Procedures / Q000379:methods*; D012421:Rupture; D013709:Tendon Transfer / Q000379:methods*