[Distal reconstruction of the Achilles tendon with a bone-tendon graft from extensor system of the knee]

The authors describe a new surgical technique of tendo achilles reconstruction using bone tendon plasty from the patellar tendon, for rare chronic ruptures of the Achilles tendon flush within its calcaneal insertion, with distal loss of substance, requiring bone fixation.

The two step operation was carried out either in lateral or ventral decubitus (the latter two involving repositioning the patient): 1) Plasty harvesting. By a short anterior approach, we harvested either a strip of patellar tendon (10 mm wide) with a piece of tibia tuberosity or a strip of rectus femoris tendon (10 mm wide, up to 10-15 cm long) with a piece of patellar bone, in cases with a greater loss of substance. Tendo achilles reconstruction: following resection of fibrous tissue, and drilling of a blind calcaneous tunnel, the bone plasty is fitted into the calcaneous with interference screw for safety, the two tendon ends are superposed and sutured. The patient is placed in a cast for two months.

Two patients (1 thirty-eight year old sportsman, 1 thirty-seven year old woman) were treated with a good morphological and functional outcome at two years.

This new technique is compared with other available solutions: triceps plasty, other local tendon plasties, artificial plasties, It met the two criteria for these unusual ruptures: solid calcaneous fixation, no skin damage.