title: A minimally invasive "overwrapping" technique for repairing neglected ruptures of the Achilles tendon.
abstract: About 10% to 25% of acute ruptures of the Achilles tendon go undiagnosed for some time beyond what would be optimal for repair and a return to optimal function. Managing these chronic or neglected ruptures is a surgical challenge, because the tendon ends retract and atrophy and could develop a short, fibrous distal stump. In the present report, a patient with a ruptured right Achilles tendon, neglected for approximately 10 years, is described. The chronically injured tendon was successfully treated by overwrapping the interposed scar at the rupture site. This minimally invasive technique restored tension to the tendon, a prerequisite for which was the presence of functional triceps surae, confirmed by identification of gross contraction of the muscle during tiptoeing. The procedure is contraindicated when the scar tissue is not intact and does not have sufficient laxity to allow adequate dorsiflexion of the ankle after overwrapping the tendon or when the triceps surae are nonfunctional.
authors.affiliation: Consultant, Department of Orthopaedics and Traumatology, North District Hospital, New Territories, Hong Kong Special Administrative Region, Sheung Shui, People's Republic of China. Electronic address: luithderek@yahoo.co.uk.
authors.forename: Tun Hing
authors.initials: TH
authors.lastname: Lui
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012421:Rupture; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*
keywords: ankle; calf; neglected rupture; overwrapping; triceps surae