SLR - April 2010 - Ashley I. Marcol
Reference:
Wang, J. (2009). Anatomic reconstruction of neglected Achilles tendon rupture with autogenous peroneal longus tendon by EndoButton fixation. Trauma, 67(5), 1109-1112.
Scientific Literature Reviews
Reviewed by: Ashley I. Marcol, DPM
Residency Program: Detroit Medical Center
Podiatric Relevance:
There are a multitude of options for treating Achilles tendon ruptures whether they be acute or chronic in nature, many of which have excellent post-surgical outcomes. The purpose of this study was to determine an alternative technique for anatomically reconstructing the Achilles tendon using an autogenous peroneal longus tendon with EndoButton-CL fixation at the calcaneal site for treatment of a patient who had a chronic neglected rupture of the Achilles tendon.
Methods:
The EndoButton fixation is known to have consistent cortical fixation and does not rely on cancellous bone quality. This was utilized as it also has a high failure load with simple rigid fixation. It was determined by the authors to use the peroneus longus tendon for autogenous grafting in the patients chronic Achilles rupture site along with the EndoButton. The procedure was performed under sterile technique with harvesting of the peroneus longus in a successful fashion. The utilization of the autologous graft in conjunction with the chosen fixation created an excellent repair of the chronic Achilles rupture site.
Results:
The authors describe the post-operative active rehabilitation course for the patient in this study. At 3 months post-procedure, this patient was allowed to begin gentle exercise, such as swimming and cycling 3 months. This patient was also encouraged to augment rehabilitation of hindfoot eversion and ankle plantar flexion. At the 2 and a half year follow-up mark, the lower extremity range of motion and strength was tested. At that point the patient's ankle plantarflexion and hindfoot eversion strength was determined to be normal and without any significant post-op side effects or changes.
Conclusions:
In podiatric surgery it is well know that a neglected or chronic rupture of the Achilles tendon usually needs a reconstruction procedure. Many graft sources have been reported for this procedure, such as a proximal V-Y gastrocnemius tendon flap, flexor hallucis longus tendon, fascia lata, plantaris tendon, synthetic materials, and peroneus brevis. Not all of these techniques solve the issue of a calcaneal site graft. This case describes an alternative technique to anatomically reconstruct the Achilles tendon using an autogenous peroneal longus tendon with EndoButton-CL fixation at the calcaneal site for treatment of a patient who had a chronic neglected rupture of the Achilles tendon. In conclusion, the authors determine that this technique, although technically difficult, was satisfactory, safe and can be duplicated in future successful Achilles ruptures.