Minimum 5-Year Outcomes After Minimally Invasive Achilles Tendon Reconstruction Using Autologous Hamstring Grafts

Area of Science:

• Orthopedic surgery
• Sports medicine
• Regenerative medicine

Background:

• Chronic Achilles tendon ruptures often result from missed diagnoses or inadequate treatment, necessitating reconstruction for tendon gaps exceeding 3 cm.
• Minimally invasive techniques using autologous hamstring grafts have demonstrated promising short-term outcomes for Achilles tendon reconstruction.
• This study aimed to evaluate the long-term efficacy and patient-reported outcomes of this minimally invasive approach with a minimum 5-year follow-up.

Purpose of the Study:

• To assess the long-term functional and subjective outcomes of minimally invasive Achilles tendon reconstruction using autologous hamstring grafts.
• To compare the long-term results of patients undergoing this procedure with healthy controls.
• To determine the stability and patient satisfaction associated with this reconstructive technique over a minimum 5-year period.

Main Methods:

• A retrospective cohort study involving 21 patients who underwent minimally invasive Achilles tendon reconstruction with autologous hamstring grafts.
• Comparison with 21 healthy controls, with diagnoses confirmed by MRI and graft stabilization using the EndoButton system.
• Assessment of patient-reported outcomes (ATRS, EQ-5D-5L), pain and satisfaction (VAS), and functional tests (dorsiflexion, calf endurance, muscle strength).

Main Results:

• Patient-reported outcomes (ATRS, EQ-5D-5L) showed improvement from 2 to 5 years postoperatively, though statistical significance was not maintained after Bonferroni correction.
• Functional test results remained stable, with the operated limb achieving over 90% of the non-operated limb's performance.
• Patients reported lower overall health scores and greater pain compared to controls, but maintained high satisfaction (VAS 9/10). One case of retear due to infection was noted.

Conclusions:

• Minimally invasive Achilles tendon reconstruction with hamstring autografts provides sustained functional and subjective improvements up to 5 years postoperatively.
• The procedure demonstrates long-term efficacy, characterized by high patient satisfaction and strong limb symmetry, despite minor residual deficits compared to uninjured individuals.
• The functional and subjective results remain stable and satisfactory in the long term, supporting the use of this technique for chronic Achilles tendon ruptures.