Repair of neglected Achilles tendon ruptures--procedure and functional results

Surgical repair of neglected Achilles tendon ruptures presents the challenge of restoring the function of the Achilles tendon complex while repairing the large defect that is created by the delay in appropriate treatment. The authors present their preferred technique for delayed repair, and the results of four patients who were available for complete follow-up evaluation. The method of repair includes: V to Y gastrocnemius recession or advancement, excision of the fibroadipose defect, end-to-end anastomosis, plantaris tendon weaving to reinforce the anastomosis, and use of a pullout-wire suture. Each of the four patients were interviewed, examined clinically, and examined via Cybex (Cybex Corporation, Long Island, New York) isokinetic strength testing. All patients related satisfaction with results, and no reruptures were encountered. All four patients have been able to return to their preinjury activities. Cybex isokinetic strength testing demonstrated peak torque deficiencies in plantar flexion ranging from 22% to 30% as compared with the unaffected limb. This deficit is believed to be the result of the gastrocnemius recession. The overall results of the described techniques indicate that very satisfactory function of a neglected tendo Achilles rupture can be obtained. A strong, clinically functional Achilles tendon complex is restored at the cost of some decrease in peak strength as detected by Cybex.