Reconstruction of neglected Achilles' tendon defect with peroneus brevis tendon allograft: a case report

This case report describes the use of a peroneus brevis allograft to reconstruct a neglected Achilles' tendon injury in a 75-year-old woman. She had difficulty walking, had stiffness, and was unable to perform a heel raise from a single-leg standing position. Magnetic resonance imaging confirmed a 6.8-cm wide defect 13 months after the initial injury. Surgical repair of the neglected rupture was performed using 4 strands of peroneus brevis allograft to bridge the defect. Early weight bearing and rehabilitation was allowed. At follow-up clinical examination 14 months postoperation, the patient could perform 15 full-range standing heel raises on the involved side versus 22 on the noninvolved side. Maximum calf circumference was 30.7 cm in the operated leg versus 33 cm at the noninvolved side. At 24 months postoperation the patient could perform 16 full-range standing heel raises on the injured leg versus 24 on the normal leg (33% deficit). The maximum calf circumference improved to 31 cm on the injured side compared with 34 cm on the noninvolved side (9% deficit). The AOFAS Ankle-Hindfoot Clinical Rating System score improved from 55 just before operation to 96 at 14 months postoperatively. The score further improved to 100 at the 2-year follow-up examination. The patient was playing recreational doubles tennis 1 to 2 times per week without symptoms.