Objective: To assess the effectiveness of repair of chronic ruptured Achilles tendon by V-Y Plasty and plantaris tendon augmentation.
Background: Treatment of chronic Achilles tendon rupture is still a challenge for most orthopedic surgeons. It is different from the acute Achilles tendon rupture as there are large gaps that will be bridged by scar tissue and muscle becomes infiltrated with fat, so ankle will be weak affecting the gait. Several techniques for reconstruction of Achilles tendon have been described, including tendon graft, turndown flap, and flexor hallucis longus augmentation and augmentation with synthetic materials. The superiority of one technique over another has not been demonstrated.
Patient and Method: This retrospective study included nine patients with chronic Achilles tendon rupture who underwent surgery in our institution, between February 2013 and April 2016. The study group consisted of 7 male and 2 female, ranging in age from 28 to 52 years old with mean age of 40 years. 6 cases were right side and 3 were left. All patients were diagnosed by clinical examination, sonographic examination and MRI. Treatment was by doing V-Y plasty of tendo-Achilles to cross large gaps with augmentation of repair by plantaris tendon in all cases.
Results: At the end of follow-up (range, 7-12 months), no major complications related to surgery occurred. No patient had re-rupture at any follow-up. All patients returned to their previous occupation. The Postoperative range of ankle movement equaled to that of the opposite side in 8 patients, but in one patient the ankle dorsi-flexion was 10° less than the contralateral side. All patients were able to stand on tip toes for 30 seconds at last follow up.
Conclusion: Several surgical treatment options were described for reconstruction of a neglected Achilles tendon rupture but without definite data that support one technique over another. Whatever the technique, the final goal of surgical treatment is to restore the length tension relationship to provide sufficient plantar flexion power. Treatment with V-Y plasty of tendo-Achilles to cross large gaps with augmentation of repair by plantaris tendon provides adequate surgical option with no major complications and no re-ruptures avoiding complications of tendon transfer.
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