Conservative treatment regimens vary greatly but commonly involve immobilisation with rigid casting or functional bracing. The foot is initially placed in full equinus (30° namely full plantarflexion). The foot is then brought into neutral sequentially over a period of 8-12 wk.
We prospectively analyzed the functional and clinical results of patients who underwent a single end-to-end suture and an augmented tendon repair with plantaris tendon at middle-term follow-up. From January 2003 to May 2005, 30 consecutive patients were operated on for the treatment of acute Achilles' tendon rupture by means of 2 different methods. No cases required adjunctive procedures to allow for acceptable end-to-end apposition.
All ruptures were acute and repairable. The patients were divided into 2 groups. In group 1, augmentation with plantaris tendon was performed in addition to the Krakow end-to-end suturing technique in 16 patients, and in group 2, only the Krakow end-to-end suturing technique was used in 14 patients. The average age of the patients was 40.6 years.
Patients in the study groups were followed up at a mean of 17.8 months after surgery. At the end of the follow-up, functional and subjective outcome scores were evaluated. The American Orthopaedic Foot and Ankle Society hindfoot clinical outcome scores were 96.7 in group 1 and 98.8 in group 2. Although there was a numerical increase in group 2, no significant difference was determined between the 2 study groups statistically. The surgical outcome concerning local tenderness, skin adhesion scar, and tendon thickness was better in group 2 than in group 1 without a statistical significance.
Although functional outcomes of both treatment groups were the same, the end-to-end suturing technique provided a safer and more reliable treatment with a low risk of complications in the treatment of acute Achilles' tendon ruptures compared with the plantaris tendon augmentation technique.
Klein recommends the use of absorbable sutures to reduce the symptoms should nerve injury occur. The Ma & Griffith repair consists of a Bunnel suture applied to the proximal tendon and a box suture distally in the stump inserted through 6 para-tendinous stab incisions.
A gap of 2 to 5 cm will usually require a V-Y slide lengthening. When the gap is more than 5 cm, V-Y advancement has been hypothesized to result in increased weakness of the muscle unit. Defects of more than 7 cm will require an Achilles turndown procedure or an allograft replacement.
The incidence of tendo-achilles rupture in the patients 30-40 years of age is increased specially in athletics to reach 75% of all cases . The tendon rupture is called neglected when the treatment is delayed more than four weeks from the date of injury . The percentage of misdiagnosis of Achilles tendon ruptures may reach 20%. The delay in treatment of AT ruptures results in soft tissue retraction with degeneration of the tendon filling the gap between the ruptured ends with fibrotic scar tissue which leads to marked functional disability. In neglected or chronic ruptures of Achilles Tendon (AT), the retraction and atrophy of the tendon ends create a gap filled with scar tissue and fibrosis which make the reconstruction difficult. The extent of the gap and the potential recovery of the muscle are factors that affect the repair after reconstruction.
In the literature, the V-Y myotendinous advancement of the (AT) augmented by multiple transfers like gastrocnemius soleus complex Bosworth technique (a “turndown" of proximal tissue of the (AT)). In the study of Us et al. they reported 23% reduction in peak torque of the tendon after a V-Y lengthening technique for neglected A T ruptures. Therefore, tendon transfer for augmentation of the V-Y advancement was recommended to augment the repair which requires lengthening to approximate the tendon ends for repair to add strength to the plantar flexion of the ankle joint. Many techniques for tendon transfers that augment the AT repair as peroneus brevis (PB) tendon, flexor digitorum longus (FDL) tendon, flexor hallucis longus (FHL) tendon . Different reports of these procedures have yielded satisfactory clinical results but the ankle flexion strength and beak torque deficits were persisted