Neglected TA Rupture Repair by Gastrocnemius Turn-down Flap and Flexor Hallucis Longus Augmentation Using Screws

Chronic and neglected tendon achilles (TA) ruptures present complex reconstructive challenges due to tendon retraction, degeneration, and soft-tissue compromise. Reconstruction using a gastrocnemius turn-down flap combined with flexor hallucis longus (FHL) tendon augmentation is widely used to restore tendon continuity and function.

This study aims to describe the surgical technique and assess the functional outcomes of chronic Achilles tendon rupture repair using a gastrocnemius turn-down flap with FHL augmentation fixed using a calcaneal screw.

The present study included 15 patients with neglected chronic Achilles tendon ruptures treated with gastrocnemius turn-down flap reconstruction and FHL tendon augmentation using calcaneal screw fixation. Bioabsorbable interference screws were used in 11 patients, whereas titanium screws were used in 4 patients based on the preoperative preference. All patients followed a standardized postoperative rehabilitation protocol. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Score and the Achilles Tendon Total Rupture Score (ATRS) preoperatively and at 6 and 12 months postoperatively. Paired t-tests were used for statistical analysis.

The mean patient age was 39.4 ± 8.03 years. The mean AOFAS score improved significantly from 52.86 ± 4.11 preoperatively to 71.06 ± 4.00 at 6 months and 89.56 ± 3.46 at 12 months (P < 0.001). The mean ATRS improved from 43.36 ± 4.38 to 66.32 ± 3.16 and 81.93 ± 3.47 at corresponding follow-ups (P < 0.001).

Gastrocnemius turn-down flap reconstruction with FHL augmentation yields significant functional improvement in neglected Achilles tendon ruptures.