title: Tension Regulation at the Suture Lines for Repair of Neglected Achilles Tendon Laceration.
abstract: BACKGROUND
  Operative intervention is the preferred option for management of the neglected laceration of the Achilles tendon. However, the commonly used techniques rarely follow the principles of the regenerative medicine for the restoration of the lost tissue. This study postulated that incorporation of the autogenous tendon graft would properly progress when the interplay between mechanical loading and healing phases was correctly applied.
  
  
  METHODS
  A prospective study included 15 patients who were treated for neglected Achilles tendon laceration using the technique of lengthening of the proximal tendon stump. An absorbable reinforcement suture was used for control of the mechanical environment at the suture lines.
  
  
  RESULTS
  By an average 5 years of the prospective follow-up, all the repaired tendons had restored continuity and length. The calf circumference equalized to the uninjured side in 12 patients. However, 3 patients had calf atrophy but they improved compared to the preoperative measurements. Sonogram confirmed the restoration of the normal thickness and the gliding characteristics of the repaired tendon.
  
  
  CONCLUSIONS
  The technique restored continuity and tension of the repaired tendon, preserved the calf circumference, and prevented peritendinous adhesions. The absorbable reinforcement suture spontaneously allowed for the mechanical loading of the grafted tendon.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: 1 Orthopaedic Department, Sohag Teaching Hospital, General Organization for Teaching Hospitals and Institutes.
authors.forename: Elsayed Ibraheem Elsayed
authors.initials: EI
authors.lastname: Massoud
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D000818:Animals; D002417:Cattle; D005205:Fascia / Q000503:physiopathology*; D006801:Humans; D022125:Lacerations / Q000601:surgery*; D011446:Prospective Studies; D012421:Rupture / Q000473:pathology / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures; D013708:Tendon Injuries / Q000503:physiopathology / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology*
keywords: Achilles tendon; autogenous graft; mechanical loading; tendon graft; tendon healing; tendon laceration; tendon repair