title: Minimally invasive reconstruction of chronic achilles tendon ruptures using the ipsilateral free semitendinosus tendon graft and interference screw fixation.
abstract: BACKGROUND
  Achilles tendon ruptures represent more than 40% of all tendon ruptures requiring surgical management. About 20% of acute Achilles tendon tears are not diagnosed at the time of injury and become chronic, necessitating more complicated management than fresh injuries. Several techniques for the reconstruction of chronic tears of the Achilles tendon have been described, but the superiority of one technique over the others has not been demonstrated.
  
  
  OBJECTIVE
  Mini-invasive reconstruction of the Achilles tendon, with a gap lesion larger than 6 cm, using the ipsilateral free semitendinosus tendon graft will result in improvement of the overall function with a low rate of complications.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Between 2008 and 2010, the authors prospectively enrolled 28 consecutive patients (21 men and 7 women; median age, 46 years) with chronic closed ruptures of the Achilles tendon who had undergone reconstruction with a free semitendinosus tendon graft. They assessed the Achilles tendon Total Rupture Score (ATRS), maximum calf circumference, and isometric plantarflexion strength before surgery and at the last follow-up. Outcome of surgery and rate of complications were also recorded. The median follow-up after surgery was 31.4 months.
  
  
  RESULTS
  The overall result of surgery was excellent/good in 26 (93%) of 28 patients. The ATRS improved from 42 (range, 29-55) to 86 (range, 78-95) (P < .0001). In the operated leg, the maximum calf circumference and isometric plantarflexion strength were significantly improved after surgery (P < .0001); however, their values remained significantly lower than those of the opposite side (P < .0001). All patients were able to walk on tiptoes and returned to their preinjury working occupation. No infections were recorded.
  
  
  CONCLUSIONS
  Mini-invasive reconstruction of the Achilles tendon, with a gap lesion larger than 6 cm, using the ipsilateral free semitendinosus tendon graft provides a significant improvement of symptoms and function, although calf circumference and ankle plantarflexion strength do not recover fully.
authors: Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK. n.maffulli@qmul.ac.uk
authors: Nicola
authors: N
authors: Maffulli
authors: Mattia
authors: M
authors: Loppini
authors: Umile Giuseppe
authors: UG
authors: Longo
authors: Gayle D
authors: GD
authors: Maffulli
authors: Vincenzo
authors: V
authors: Denaro
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000842:Ankle / Q000000981:diagnostic imaging / Q000503:physiopathology; D001863:Bone Screws; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007537:Isometric Contraction; D007866:Leg / Q000033:anatomy & histology; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D053580:Muscle Strength; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D012421:Rupture / Q000601:surgery; D013710:Tendons / Q000637:transplantation*
keywords: Achilles tendon; chronic ruptures; mini-invasive surgery; semitendinosus tendon graft