Semitendinosus Tendon Autograft for Reconstruction of Large Defects in Chronic Achilles Tendon Ruptures.
BACKGROUND
Chronic Achilles tendon ruptures are associated with considerable functional morbidity. When treated operatively, debridement of degenerated tendon ends may create large defects. Various procedures to reconstruct large defects have been described. We present a simple technique in which an autologous semitendinosus tendon graft is used to reconstruct defects larger than 5 cm in chronic Achilles tendon ruptures. The purpose of this study was to describe our operative technique and its functional outcome.


METHODS
Achilles ruptures of more than 6 weeks duration were considered for the study. We treated 35 patients (20 males, 15 females) with symptomatic chronic Achilles tendon ruptures. The mean age was 47.4 years (range, 30 to 59). The smallest defect that we had reconstructed was 5 cm, and the largest was 9 cm in length. The average follow-up duration was 30.7 months (range, 20 to 42). Postoperatively, the strength of gastrocsoleus was measured by manual muscle testing (MMT) in non-weight-bearing and weight-bearing positions.


RESULTS
All operated patients showed satisfactory functional outcome, good soft tissue healing, and no reruptures. The preoperative weight-bearing MMT of 2/5 improved to 4/5 or 5/5 postoperatively. In all patients, postoperative non-weight-bearing MMT was 5/5. All patients returned to their prerupture daily activity.


CONCLUSIONS
We present a technique that is simple, with low morbidity. We believe it is a valuable option especially when allografts are not available. It is inexpensive as suture anchors or tenodesis screws are not used. This can be a useful option if other tendons (flexor hallucis longus, peroneus brevis, etc) are not available for transfer.


METHODS
Level IV, retrospective case series.
Orthopaedic Department, Noble Hospital, Pune, Maharashtra, India sampatdumbre@gmail.com.
Sampat Shivajirao
SS
Dumbre Patil
Noble Hospital, Pune, Maharashtra, India.
Vaishali Sampat
VS
Dumbre Patil
Shri Prayag Dham Trust Charitable Hospital, Uruli Kanchan, Pune, Maharashtra, India.
Vikas Rajeshwarrao
VR
Basa
Shri Prayag Dham Trust Charitable Hospital, Uruli Kanchan, Pune, Maharashtra, India.
Ajay Birappa
AB
Dombale
D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000328:Adult; D064592:Autografts; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012421:Rupture / Q000601:surgery; D013708:Tendon Injuries / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome
Achilles tendon reconstruction; chronic Achilles rupture; semitendinosus tendon