There are many different ways to approach the problem of a chronic Achilles tendon rupture. Surgery is usually necessary when there is a large gap between the tendon “stump” (end of tendon that ruptured and pulled away) and the bone where the tendon is supposed to attach.
After an acute injury, repair of the torn tendon may be possible. But in the case of older injuries (referred to as chronic ruptures), the ruptured tendon stump becomes thin and atrophied. It can no longer be pulled back up and reattached. That’s when reconstruction surgery becomes the necessary treatment approach. But which surgical technique (there are several) works the best remains unknown.
The results after using a hamstring tendon graft in a series of 28 patients was recently reported. In this study, surgeons at a single-center reviewed the results of their 28 patients. The patients ranged in age from 28 years old up to 66 years old. Two-thirds of the group were men and the remaining one-third were women.
Each patient was treated for chronic closed rupture of the Achilles tendon. The surgeons chose to use a tendon graft from the hamstring muscle (the semitendinosus portion of the hamstrings). The hamstring tendon is long enough to bridge the wide Achilles tendon gap. It is easy to harvest with quick recovery for the patient. The knee does not suffer significant loss of function in terms of strength and power. And the semitendinosus can grow back in time. The entire procedure can be done with minimally invasive techniques and few (if any) complications.
Patients in the case series were followed for two to three years. The mid-term results were reported based on improvement of overall function and rate of complications. Calf circumference and strength were also measured and compared from before surgery to after surgery. Outcomes of surgical management are summarized in a table. Twenty of the 28 patients had no pain after surgery. The remaining eight people had mild to moderate pain; no one reported severe pain.
Daily activities were resumed by all but two patients. Some patients reported limited recreational activity. Only two people were bothered by shoes (usually the more fashionable, less supportive type of footwear). And in the end, 22 of the 28 patients were satisfied with the results. No one was dissatisfied; a few were happy with the results but had a few reservations.
In terms of post-operative problems, there were no infections, nerve injuries, reruptures, or blood clots to complicate matters. There was significant overall improvement of symptoms and function. So although the best approach to the surgical management of chronic Achilles tendon ruptures remains unknown, this study added some perspective on the subject by showing that using hamstring tendon grafts results in good clinical outcomes.