title: Treatment of Chronic Achilles Tendon Ruptures With Large Defects.
abstract: Background When Achilles tendon ruptures become chronic, a defect often forms at the rupture site. There is scant literature regarding the treatment of chronic Achilles ruptures with defects of 6 cm or larger. We examined outcomes from combining a turndown of the proximal, central Achilles with a flexor hallucis longus (FHL) tendon transfer to treat this condition. Materials Between September 2002 and December 2013, 32 patients presented with a chronic Achilles rupture and a defect of 6 cm or more. Twenty patients were male and 12 were female. Patient age was between 20 and 74 years, with a mean of 53.3 years. Eighteen and 14 patients had their right and left Achilles tendon affected, respectively. The number of days between injury and surgery ranged from 30 to 315 days, with a mean of 102 days. Reconstruction of the Achilles involved a turndown of the proximal, central tendon and FHL augmentation. Final patient follow-up ranged from 18 to 150 months, with a mean of 62.3 months.
  
  
  RESULTS
  At surgery, the gap between the ruptured ends of the Achilles ranged from 6 to 12 cm, with a mean gap of 7.5 cm. Full healing was achieved in all 32 patients (100%) by 5 months postoperatively. Mean Foot and Ankle Ability Measures scores increased from 36.3% to 90.2% between initial and latest follow-up (P < .05). Mean visual analogue scales of pain decreased from 6.6 to 1.8 of 10 between first and last encounter (P < .05). Postoperative complications occurred in 5 patients (15.6%), including 3 (9.4%) superficial wound problems, 1 (3.1%) deep wound infection, and 1 (3.1%) deep vein thrombosis. Discussion Outcomes from treating chronic Achilles ruptures with large defects are scant within the orthopaedic literature. Our method of Achilles reconstruction results in a high rate of improved function and pain relief.
  
  
  METHODS
  Therapeutic, Level IV: Case series.
authors.affiliation: Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania jamal.ahmad@rothmaninstitute.com.
authors.forename: Jamal
authors.initials: J
authors.lastname: Ahmad
authors.affiliation: Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Kennis
authors.initials: K
authors.lastname: Jones
authors.affiliation: Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Raikin
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011182:Postoperative Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery*; D013536:Suture Techniques; D013709:Tendon Transfer / Q000379:methods*; D064232:Visual Analog Scale; D014945:Wound Healing
keywords: Achilles tendon; chronic; defect; gap; rupture; turndown