Rupture of the Achilles tendon often leads to long-term morbidity, particularly calf weakness associated with tendon elongation. Operative repair of Achilles tendon ruptures leads to reduced tendon elongation. Tendon lengthening is a key problem in the restoration of function following Achilles tendon rupture. A study was performed to determine differences in initial separation, strength and failure characteristics of differing sutures and numbers of core strands in a percutaneous Achilles tendon repair model in response to initial loading.
Nineteen bovine Achilles tendons were repaired using a percutaneous/minimally invasive technique with a combination of a modified Bunnell suture proximally and a Kessler suture distally, using non-absorbable 4-strand 6-strand repairs and absorbable 8-strand sutures. Specimens were then cyclically loaded using phases of 10 cycles of 100 N, 100 cycles of 100 N, 100 cycles of 190 N consistent with early range of motion training and weight-bearing, before being loaded to failure.
Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Recent studies have shown little difference in outcome between the techniques of open and non-operative treatment using an early active rehabilitation programme. Meta-analyses have shown that non-operative management has increased risk of re-rupture whereas surgical intervention has risks of complications related to the wound and iatrogenic nerve injury. Minimally invasive surgery has been adopted as a way of reducing infections rates and wound breakdown however avoiding iatrogenic nerve injury must be considered. We discuss the techniques and outcomes of percutaneous and minimally invasive repairs of the Achilles tendon.
A double V-Y advancement flap based upon a vertical subcutaneous pedicle was assessed for reconstruction of moderate sized defects of the anterior lower leg. The technique is described and the results of a retrospective analysis of thirteen cases are given. The procedure has proven to be a reliable alternative means of providing skin cover in this area.
The Achilles tendon is one of the most commonly ruptured tendons of the lower extremity . Clinically, acute Achilles tendon rupture can be easily diagnosed and cured; however, a significant number of cases are still neglected without treatments. Chronic Achilles tendon rupture is usually defined as the rupture that occurs in 4 to 6 weeks after injury . The symptoms of chronic Achilles tendon rupture include pain, decreased strength, fatigue, and ankle stiffness. During physical examination, a palpable gap between the rupture ends can be observed. Chronic Achilles tendon rupture often occurs 2 to 6 cm proximal to the stumps, but it sometimes can also be observed at the stumps. Usually, small gaps (less than or equal to 2 mm) of chronic Achilles tendon rupture can be directly closed in an end-to-end manner. However, there is still no standard treatment for chronic Achilles tendon rupture with large gaps. Recently, Den Hartog used an flexor halluces longus tendon (FHLT) transfer for all defects over 2 cm. But Park and Sung deemed that gaps greater than 4 cm in chronic Achilles tendon rupture that underwent various reconstruction methods depending on the state of the remaining could achieve good outcomes.