Clinical Outcomes and Return to Sports in Patients with Chronic Achilles Tendon Rupture after Minimally Invasive Reconstruction with Semitendinosus Tendon Graft Transfer

Abstract

Objective The purpose of the study is to evaluate the clinical results and return to sports in patients undergoing reconstruction of the Achilles tendon after minimally invasive reconstruction with semitendinosus tendon graft transfer.

Methods Eight patients underwent surgical reconstruction with a minimally invasive technique and tendon graft augmentation with ipsilateral semitendinosus tendon for chronic Achilles tendon rupture (more than 30 days after the injury and a gap of >6 cm). Patients were evaluated at a minimum follow-up of 24 months after the surgery through the American Orthopaedic Foot and Ankle Society (AOFAS), the Achilles Tendon Total Rupture Scores (ATRS), the Endurance test, the calf circumference of the operated limb, and the contralateral and the eventual return to sports activity performed before the trauma.

Results The mean age at surgery was 50.5 years. Five men and three women underwent the surgery. The average AOFAS was 92, mean Endurance test was 28.1, and the average ATRS was 87. All patients returned to their daily activities, and six out of eight patients have returned to sports activities prior to the accident (two football players, three runners, one tennis player) at a mean of 7.0 (range: 6.7–7.2) months after the surgery. No patient reported complications or reruptures.

Conclusion Our study confirms encouraging results for the treatment of Achilles tendon rupture with a minimally invasive technique with semitendinosus graft augmentation. The technique can be considered safe and allows patients to return to their sports activity.

Level of Evidence Level IV, therapeutic case series.

Keywords

chronic Achilles tendon rupture - tendon transfer - return to sport

• References

• 1 Ganestam A, Kallemose T, Troelsen A, Barfod KW. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc 2016; 24 (12) 3730-3737
• 2 Usuelli FG, Grassi M, Maccario C. , et al. Intratendinous adipose-derived stromal vascular fraction (SVF) injection provides a safe, efficacious treatment for Achilles tendinopathy: results of a randomized controlled clinical trial at a 6-month follow-up. Knee Surg Sports Traumatol Arthrosc 2017;
• 3 Maffulli N, Ajis A, Longo UG, Denaro V. Chronic rupture of tendo Achillis. Foot Ankle Clin 2007; 12 (04) 583-596
• 4 Gabel S, Manoli II A. Neglected rupture of the Achilles tendon. Foot Ankle Int 1994; 15 (09) 512-517
• 5 Maffulli N, Dymond NP, Capasso G. Ultrasonographic findings in subcutaneous rupture of Achilles tendon. J Sports Med Phys Fitness 1989; 29 (04) 365-368
• 6 Myerson MS. Achilles tendon ruptures. Instr Course Lect 1999; 48: 219-230
• 7 Padanilam TG. Chronic Achilles tendon ruptures. Foot Ankle Clin 2009; 14 (04) 711-728
• 8 Longo UG, Ronga M, Maffulli N. Achilles tendinopathy. Sports Med Arthrosc Rev 2009; 17 (02) 112-126
• 9 Maffulli N, Longo UG, Gougoulias N, Denaro V. Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon. BMC Musculoskelet Disord 2008; 9: 100
• 10 Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med 1998; 26 (02) 266-270
• 11 Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994; 15 (07) 349-353
• 12 Nilsson-Helander K, Thomeé R, Silbernagel KG. , et al. The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med 2007; 35 (03) 421-426
• 13 Paavola M, Kannus P, Orava S, Pasanen M, Järvinen M. Surgical treatment for chronic Achilles tendinopathy: a prospective seven month follow up study. Br J Sports Med 2002; 36 (03) 178-182
• 14 Lunsford BR, Perry J. The standing heel-rise test for ankle plantar flexion: criterion for normal. Phys Ther 1995; 75 (08) 694-698
• 15 Hunt KJ, Hurwit D. Use of patient-reported outcome measures in foot and ankle research. J Bone Joint Surg Am 2013; 95 (16) e118 , 1–9
• 16 Longo UG, Lamberti A, Maffulli N, Denaro V. Tendon augmentation grafts: a systematic review. Br Med Bull 2010; 94: 165-188
• 17 Wapner KL, Pavlock GS, Hecht PJ, Naselli F, Walther R. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle 1993; 14 (08) 443-449
• 18 Jacob HA. Forces acting in the forefoot during normal gait--an estimate. Clin Biomech (Bristol, Avon) 2001; 16 (09) 783-792
• 19 Carmont MR, Maffulli N. Less invasive Achilles tendon reconstruction. BMC Musculoskelet Disord 2007; 8: 100
• 20 Maffulli N, Del Buono A, Spiezia F, Maffulli GD, Longo UG, Denaro V. Less-invasive semitendinosus tendon graft augmentation for the reconstruction of chronic tears of the Achilles tendon. Am J Sports Med 2013; 41 (04) 865-871
• 21 Sarzaeem MM, Lemraski MM, Safdari F. Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer. Knee Surg Sports Traumatol Arthrosc 2012; 20 (07) 1386-1391
• 22 Dumbre Patil SS, Dumbre Patil VS, Basa VR, Dombale AB. Semitendinosus tendon autograft for reconstruction of large defects in chronic Achilles tendon ruptures. Foot Ankle Int 2014; 35 (07) 699-705
• 23 Pintore E, Barra V, Pintore R, Maffulli N. Peroneus brevis tendon transfer in neglected tears of the Achilles tendon. J Trauma 2001; 50 (01) 71-78
• 24 Carmont MR, Maffulli N. Management of insertional Achilles tendinopathy through a Cincinnati incision. BMC Musculoskelet Disord 2007; 8: 82
• 25 Del Buono A, Volpin A, Maffulli N. Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review. Br Med Bull 2014; 109: 45-54
• 26 Ardern CL, Webster KE, Taylor NF, Feller JA. Hamstring strength recovery after hamstring tendon harvest for anterior cruciate ligament reconstruction: a comparison between graft types. Arthroscopy 2010; 26 (04) 462-469
• 27 Papandrea P, Vulpiani MC, Ferretti A, Conteduca F. Regeneration of the semitendinosus tendon harvested for anterior cruciate ligament reconstruction. Evaluation using ultrasonography. Am J Sports Med 2000; 28 (04) 556-561
• 28 Kearney RS, Achten J, Lamb SE, Plant C, Costa ML. A systematic review of patient-reported outcome measures used to assess Achilles tendon rupture management: what's being used and should we be using it?. Br J Sports Med 2012; 46 (16) 1102-1109