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A Novel Tenorrhaphy Suture Technique with Tissue Engineered Collagen Graft to Repair Large Tendon Defects

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Strength and Functional Outcomes Following Achilles Tendon Reconstruction With Hamstring Tendon Autograft

Stephanie K Eble^1,2, Oliver B Hansen¹, Saanchi K Kukadia¹

¹Hospital for Special Surgery, New York, NY, USA.

Foot & Ankle International

|March 4, 2024

Summary

Achilles tendon reconstruction using hamstring autografts offers good functional recovery for patients with severe Achilles pathology. While some calf strength deficits may persist, patients can return to symptom-free physical function and athletic activities.

Keywords:

Achilles rupture Achilles tendon reconstruction foot and ankle hamstring autograft sports

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Area of Science:

Orthopedic Surgery
Sports Medicine
Biomedical Engineering

Background:

Hamstring autografts are proposed for Achilles reconstruction due to improved healing and biomechanics compared to alternatives like flexor hallucis longus (FHL) transfer.
This study investigates the strength and functional outcomes of Achilles tendon reconstruction utilizing hamstring autografts.

Purpose of the Study:

To evaluate the effectiveness of hamstring autograft Achilles tendon reconstruction.
To assess strength and functional outcomes in patients undergoing this procedure.

Main Methods:

Retrospective analysis of 46 patients with Achilles pathology treated with hamstring autograft reconstruction (12 augmented with FHL transfer).
Isokinetic testing (Biodex dynamometer) for knee and ankle strength.
Pre- and postoperative outcome scores (FAOS/PROMIS) collected.

Main Results:

Peak ankle plantarflexion torque was significantly weaker postoperatively at both slow and fast speeds.
Knee extension strength was significantly weaker at faster testing speeds.
Patient-reported outcome scores for physical function and pain significantly improved postoperatively.

Conclusions:

Achilles reconstruction with hamstring autograft (± FHL transfer) enables good subjective function and return to activity in complex cases.
Modest calf strength deficits were observed, but overall knee flexion strength remained unimpaired.
Hamstring autograft reconstruction is a viable option for severe Achilles pathology when healthy tissue is limited.