Abstract
The operative and non-operative treatment options for acute tendo achilles rupture are well documented in the literature. The management of late presenting tendon rupture is usually operative, and can be complicated by acute shortening of the muscle-tendon unit and leave repairs under tension, which may lead to re-rupture. We report the use of the sliding graft technique for reconstruction of late presenting rupture.
A proximal intra muscular Z lengthening through a separate incision facilitates distal translation of the proximal tendon stump, allowing direct repair distally with minimum tension.
Post operatively a below knee cast is applied for six weeks with progressive dorsiflexion at two weekly intervals.
A dorsiflexion restriction splint accompanies early physiotherapy for a further six weeks with unprotected weight bearing commencing at three months.
There were eleven patients in the study group with an average follow up of 13 months. All tendons united. There were no re-ruptures. Two distal wound breakdowns occurred and one of these healed by secondary intention.
Good single stance power returned in patients with smaller separations but greater calf wasting and weakness was observed in those patients with large separations.
We conclude that this technique can be employed for the reconstruction of late presenting tendo achilles ruptures but great care is required with soft tissue dissection distally.
Consideration could be given to deep flexor transfers in the widely separated case.
These abstracts were prepared by Squadron Leader G. Pathak FRCS (Trauma & Orth). Correspondence should be addressed to him at Royal Hospital Haslar, Gosport, Hampshire PO12 2AA.
