Ipsilateral free semitendinosus graft with interference screw fixation for surgical management of insertional acute Achilles tendon tears

• Published in: Injury 2020-08, Vol.51, p.S73-S79
• Main Authors: Maffulli, Nicola, D'Addona, Alessio, Gougoulias, Nikolaos, Oliva, Francesco, Maffulli, Gayle D.
• Format: Article
• Language: English
• Subjects: Achilles tendon; Acute rupture; Insertional avulsion; Minimally invasive; Semitendinosus graft
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2019.11.013

•Ruptures of Achilles tendon at its calcaneal insertion are uncommon.•End to end repair is usually not feasible, due to poor quality tissue.•Using free semitendinosus tendon graft is a reconstructive option.•The minimally invasive technique described was safe and offered good functional outcomes. Very distal tears of the Achilles tendon are uncommon, and poor quality tendinous tissue of the calcaneal stump can compromise healing. Little has been published about the characteristics and surgical management of such injuries. We present a surgical technique, developed by the senior author, to restore continuity of the gastrosoleus-Achilles tendon-calcaneus complex using a free ipsilateral semitendinosus graft, and clinical outcomes of a case series of 28 consecutive patients. Our hypothesis was that this is a safe technique, and patients can return to pre-injury occupation and athletic activities. A total of 28 patients (mean age 46 years) underwent minimally invasive reconstruction using a free ipsilateral semitendinosus graft for acute insertional rupture of tendo Achillis. The procedure required two small incisions along the course of the Achilles tendon, and one posteromedial incision at level of the ipsilateral knee to harvest the semitendinosus tendon. Patients were assessed at minimum 2 years (range, 2–2.5 years) following the index procedure. The median Achilles tendon Rupture Score (ATRS) at the latest follow-up was 88. Two patients developed a superficial wound infection. All patients returned to their preinjury occupation, whilst 22 out of 28 patients (79%), returned to their preinjury level of physical activity at a mean of 6.7 months after surgery, reporting good or excellent overall satisfaction in 88.5% of cases. This minimally invasive technique was safe, and allowed most of patients to return to preinjury daily and sport activities within 9 months from surgery.