Chronic Achilles Tendon Rupture Reconstruction with Semitendinous Autograft Tendon: A Case Series

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 objetive of this study is evaluate the functional outcomes after Achilles tendon reconstruction with ST. Methods: Prospective case series, level IV of evidence, authorized by Ethics Committee of our institution, assessed the clinical outcome of patients submitted to achilles tendon reconstruction between march 2021 and june 2022. The patients 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 ST length was measured intraoperatively. AOFAS Hindfoot Score and Achilles Tendon Total Rupture Score (ATRS) were evaluated pre and postoperatively (last evaluation). Results: 20 patients were included, with medium age of 45 years old (range 23 to 64 )and medium gap of 6,3 cm (range 6 to 6,6). (Table 1). The pre and postoperative AOFAS-hindfoot was 71 (range 48 to 83) and 89 (range 81 to 97), respectively, and the pre and posoperative ATRS was 33 (range 30 to 47) and 88 (range 86 to 92), respectively, both with statistic significance. The medium lenght of the ST from the posterior approach was 26.3 cm and the medium VAS for pain in the ST incision was 1. There were 2 cases of superficial infection treated with oral antibiotics for 7 days of full resolution and 1 case of superficial dehiscence treated with wound dressing. Conclusion: The surgical reconstruction of AT using ST harvested from posterior approach is a safe and reliable method for treatment of chronic AT ruptures with a gap larger than 6 cm, with a significant improvement in funcional scores and just 15% of minor complications.