title: Surgical management of Achilles tendon re-ruptures: a prospective cohort study.
abstract: OBJECTIVE
  The purpose of this study was to compare outcomes of different minimally invasive techniques for reconstruction of Achilles tendon re-ruptures.
  
  
  METHODS
  We prospectively enrolled 21 patients undergoing minimally invasive reconstruction using a transfer of the ipsilateral peroneus brevis (PB) (five patients) or the free ipsilateral semitendinosus tendon (ST) graft with or without interference screw fixation (ten and six patients, respectively). We assessed the maximum calf circumference and isometric plantar flexion strength before surgery and at the last follow up. The Achilles tendon total rupture score (ATRS) and number of single-leg heel lifts on the affected leg were evaluated at the last follow up. The median follow up was 39 months.
  
  
  RESULTS
  The outcome of surgery was excellent/good in 17 (81 %) of 21 patients. In the operated leg, the maximum calf circumference and isometric plantar flexion strength were significantly improved after surgery (P < 0.0001). The average ATRS was 86 (range 79-92), and the average number of single-legged heel lifts was 33 (range 11-48). No further re-ruptures were recorded.
  
  
  CONCLUSIONS
  Minimally invasive ipsilateral PB transfer and free ipsilateral ST graft with or without interference screw fixation are safe and effective procedures to reconstruct the Achilles tendon after a re-rupture, providing a significant improvement of the symptoms and function in the mid term.
authors: Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy, n.maffulli@qmul.ac.uk.
authors: Nicola
authors: N
authors: Maffulli
authors: Francesco
authors: F
authors: Oliva
authors: Angelo
authors: A
authors: Del Buono
authors: Antonietta
authors: A
authors: Florio
authors: Gayle
authors: G
authors: Maffulli
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000328:Adult; D001863:Bone Screws; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012008:Recurrence; D012086:Reoperation; D012421:Rupture; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
references: Am J Sports Med. 1998 Mar-Apr;26(2):266-70
references: 9548122
references: J Bone Joint Surg Am. 2008 Jun;90(6):1348-60
references: 18519331
references: Am J Sports Med. 2010 Nov;38(11):2304-12
references: 20802093
references: Am J Sports Med. 2010 Nov;38(11):2186-93
references: 20802094
references: Am J Sports Med. 2013 May;41(5):1100-7
references: 23467554
references: Clin Biomech (Bristol, Avon). 2001 Nov;16(9):783-92
references: 11714556
references: Cochrane Database Syst Rev. 2010 Sep 08;(9):CD003674
references: 20824836
references: Bull Hosp Joint Dis. 1975 Apr;36(1):48-51
references: 1201365
references: Arthroscopy. 2010 Apr;26(4):462-9
references: 20362824
references: Int Orthop. 2013 Apr;37(4):625-9
references: 23250350
references: J Bone Joint Surg Br. 2011 Aug;93(8):1071-8
references: 21768631
references: Foot Ankle Clin. 2007 Dec;12(4):583-96, vi
references: 17996617
references: Foot Ankle Spec. 2011 Apr;4(2):77-81
references: 21123666
references: Orthop Clin North Am. 2009 Oct;40(4):491-8, viii-ix
references: 19773054
references: BMC Musculoskelet Disord. 2007 Oct 26;8:100
references: 17963499
references: J Trauma. 2001 Jan;50(1):71-8
references: 11231673
references: Int Orthop. 2012 Aug;36(8):1629-34
references: 22426931
references: Int Orthop. 2012 Apr;36(4):765-73
references: 22159659
references: Am J Sports Med. 2007 Mar;35(3):421-6
references: 17158277
references: Foot Ankle Int. 2008 Apr;29(4):367-77
references: 18442450
references: Clin Orthop Relat Res. 1979 May;(140):175-7
references: 477072
references: J Bone Joint Surg Am. 1999 Jul;81(7):1019-36
references: 10428136
references: J Bone Joint Surg Am. 2002 Nov;84-A(11):2016-21
references: 12429764
references: Clin J Sport Med. 1999 Jul;9(3):157-60
references: 10512344
references: Clin Orthop Relat Res. 1995 Aug;(317):150-8
references: 7671470
references: Foot Ankle Clin. 2005 Jun;10(2):255-66
references: 15922917
references: Knee Surg Sports Traumatol Arthrosc. 2010 Feb;18(2):269-73
references: 19838670
references: Am J Sports Med. 2003 Sep-Oct;31(5):692-700
references: 12975188
references: Practitioner. 1957 Jul;179(1069):56-8
references: 13453094
references: J Bone Joint Surg Am. 2012 May 16;94(10):901-5
references: 22617917
references: Muscles Ligaments Tendons J. 2012 Apr 01;1(4):134-7
references: 23738261
references: J Bone Joint Surg Am. 2010 Dec 1;92(17):2767-75
references: 21037028