management
Last reviewed 01/2018
Management of chronic tendon rupture is a demanding task due to the presence of tendon retraction, muscle atrophy, and skin contracture that is frequently present around the tendon (1)
Conservative management
- can be attempted in patients who refuse surgery or are contraindicated
- brace or ankle-foot orthosis can be used
- in a series of fifty-one patients with fifty seven ruptures (out of which nearly two-thirds were chronic ruptures) eighteen were treated conservatively
- satisfactory results were seen in ten of these eighteen patients e.g. - the gait was normal, the patient returned to his or her previous occupation, and there was slight or no discomfort)
- recovery time of these patients were long sometimes over several years
- however the results were poor when compared to patients who were managed surgically (1,2)
Surgical management
- optimal technique for treating chronic Achilles tendon rupture is controversial. Operative procedures for treatment of chronic rupture include:
- end to end anastamosis
- flap tissue turn down using one and two flaps
- V-Y advancement flap - anastomosis of the tendon ends is achieved by making an inverted V-shaped incision in the proximal part of the tendon and repairing it in a Y-shaped fashion
- gastrocnemius fascial turndown flap
- local tendon transfer
- peroneus Brevis tendon transfer
- flexor halluces longus tendon (FHLT) transfer
- autologous free tendon grafts
- gracilis tendon
- allografts (1,2)
- according to the length of the defect, two classification systems have been proposed for the surgical management of the condition
- Myerson’s classification
- type-1 defect is no more than 1 to 2 cm long - managed with end-to-end repair and a posterior compartment fasciotomy
- type-2 defect ranges between 2 and 5 cm - managed with V-Y lengthening, with or without a tendon transfer
- type-3 defect is >5 cm - bridged with use of a tendon transfer, alone or in combination with a V-Y advancement (1,2)
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