Abstract
Chronic ruptures of the tendo-achilles in young individuals pose difficult therapeutic problems. Surgical repair Is necessary to achieve optimum functional results. We present our results using a modified Bosworth technique using a ‘turn-down’ strip of gastrosoleus aponeurosis
Materials and methods: 11 patients (9 Males:2 Females) Age range: 23–51 (average 36) Time since rupture: 9–20 weeks (average 13). All had pain, weak or absent push-off and restricted ADL.
Technique: Posterior midline incision – rupture exposed, ends debrided – 1” strip of gastrosoleus aponeurosis about 2–3” long – detatched proximally ‘turned down’ with fascial surface anterior. This modification was to avoid tissue bulge at proximal end of incision. The fascial strip was approximated with delayed absorbable sutures. The plantaris was used to supplement the repair when possible.
Cast-bracing for 9 weeks. FU – 12–42 months, minimum 12. All patients independently assessed at one year. AOFAS hindfoot scores – Preop and 1 year postop
Results: AOFAS scores: Preop: 49 (40–61) Postop: 82(70–94) 2 minor wound problems-no surgical intervention required. Push-off strength returned to about 70–80% in all patients. 7/11 patients returned to preop recreational activities.
We conclude that this is a safe and predictable repair technique in this group of patients. It is technically easy, restores tendon length and provides excellent functional improvement.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
