Comparative Study between Semitendinous Autograft Tendon Length Harvested in Ventral vs Dorsal Decubitus

Abstract

Category: Sports; Ankle Introduction/Purpose: Chronic Achilles tendon ruptures is challenging because the tendon ends are usually retracted, and if the gap between the proximal and distal stumps are of more than 6 cms with the ankle in plantarflexion the currently literature shows that semitendinous tendon (ST) autograft reconstruction has satisfactory funcional outcome. The usual anteromedial approach for ST harvest might be more demanding with the patient in ventral decubitus, requiring knee flexion and a change of perspective. The posterior approach offers direct access to the ST but some questions might be raised about the tendon length obtained, once the incision is made 5 to 8 cm proximal to its insertion. The objetive of this study is to compare the ST length obtained from posterior and anteromedial approach. Methods: Prospective comparative study, level III of evidence, authorized by Ethics Committee of our institution, assessed the ST length obtained by anteromedial and posterior approach (image 1) in patients submitted to anterior cruzade ligament (ACL) reconstruction and achilles tendon reconstruction, respectively, between March 2021 and June 2022. The patients with chronic achilles tendon rupture were diagnosed by 2 orthopaedic foot and ankle surgeons board certificated and were subjected to the following inclusion criteria: age between 18-60 years, agreeing to participate, with chronic achilles tendon rupture (> 12 weeks) and gap between proximal and distal stump larger than 6cm confirmed by ultrasound with the ankle in plantarflexion position. Demographic data was obtained, including gender, BMI and height and the full tendon length intraoperatively and Visual Analog Scale (VAS) 6 weeks was applied postoperatively. Results: In the Achilles group 20 patients were included, with medium age of 45 years old and medium gap of 6.3 cm. In ACL group 20 patients were included, with medium age of 30.9 years old. The medium BMI was 27.9 and 26.2 in posterior and anterior approach, respectively. The medium lenght of the ST from the posterior approach was 26.3 cm and the from the anteromedial approach was 26.9 cm, with no statistic difference between groups. The VAS for pain after six weeks had no statistic difference between approachs but the anteromedial approach had 15% of numbness on the correspondent area of the safenous nerve. There were no complications reported in the posterior approach. Conclusion: There was no difference in the ST length between posterior and anteromedial approach, with more complications in the anteromedial approach. During achilles tendon reconstruction, the use of the posterior approach is a safe, more direct and easy approach and non inferior in terms of tendon length extraction, and should be consider the first option for tendon harvest in this procedure.