title: Treatment of chronic Achilles tendon rupture by shortening suture and free sural triceps aponeurosis graft.
abstract: BACKGROUND
  The Bosworth technique is old but still widely used. It involves problems of precisely determining the length of the Achilles tendon and of a volume effect in the turndown area.
  
  
  OBJECTIVE
  A new reconstruction technique is assessed, based on free sural triceps aponeurosis transfer without turndown, associated to tendon shortening suture.
  
  
  METHODS
  Twenty-three patients were assessed by AOFAS score and clinical examination (plus MRI in 14 cases) at a mean 24.5 months' follow-up. Mean age was 52.1 years. Mean pre-operative AOFAS score was 63.6/100.
  
  
  RESULTS
  Mean postoperative AOFAS score was 96.1. Mean graft length was 7.5 cm. Surgical revision was required for one case of postoperative infection. Twelve patients resumed leisure sports at their previous level by a mean 9.4 ± 2 months; three competitive sportsmen resumed sport at their previous level by a mean 7.6 months. None were dissatisfied or disappointed with their operation. MRI performed at 1 year found increased tendon volume without abnormality in 57% of cases; 43% showed abnormal images.
  
  
  CONCLUSIONS
  Functional results were comparable to literature reports. It can be difficult to determine Achilles length for the Bosworth technique: this is made easier by conserving a fibrous support of a length determined with reference to the healthy side. The technique avoids aponeurosis turndown, and thus avoids the problem of plasty volume effect. The two cases of cutaneous complication occurred in the two most elderly patients, raising the question of the indications for reconstructive surgery in the elderly. The abnormalities found on MRI concerned scar tissue remodeling in patients with good or excellent clinical results.
  
  
  METHODS
  Level IV, retrospective study.
authors.affiliation: Service de chirurgie orthopédique et traumatologie, Hôpital de Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France. frederic.khiami@psl.aphp.fr
authors.forename: F
authors.initials: F
authors.lastname: Khiami
authors.forename: M
authors.initials: M
authors.lastname: Di Schino
authors.forename: E
authors.initials: E
authors.lastname: Sariali
authors.forename: D
authors.initials: D
authors.lastname: Cao
authors.forename: E
authors.initials: E
authors.lastname: Rolland
authors.forename: Y
authors.initials: Y
authors.lastname: Catonné
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000637:transplantation*; D019637:Orthopedic Procedures / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012421:Rupture / Q000601:surgery; D013536:Suture Techniques; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: AOFAS score; Achilles tendon; Neglected rupture