title: Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation.
abstract: BACKGROUND
  The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results.
  
  
  METHODS
  Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion.
  
  
  RESULTS
  The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage.
  
  
  CONCLUSIONS
  All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Department of Orthopaedics, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, India.
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Gedam
authors.affiliation: Department of Orthopaedics, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, India faizaanr@gmail.com.
authors.forename: Faizaan M
authors.initials: FM
authors.lastname: Rushnaiwala
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000328:Adult; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D000070633:Hamstring Muscles / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D013524:Surgical Flaps; D013708:Tendon Injuries / Q000601:surgery*
keywords: chronic Achilles tendon rupture; minimally invasive; semitendinosus augmentation; turndown flap