FA2: FUNCTIONAL RESULTS OF RECONSTRUCTION OF NEGLECTED ACHILLES TENDON RUPTURE WITH GASTROCNEMIUS TURN DOWN FLAP WITH FLEXOR HALLUCIS LONGUS AUGMENTATION

Abstract

The aim is to review the functional results of reconstruction of neglected Achilles Tendon Ruptures, in which the gap between the ruptured ends was a minimum of 6 cm. All ruptures had a gap of 6–8cm, intraoperatively, between the ruptured ends when the foot was put into plantigrade.

There are 9 patients in our case series, who presented with neglected Achilles Tendon ruptures over a six year period. All reconstructions were done by a single surgeon. All patients had a a reconstruction done using 2 strips of gastrocnemius aponeurosis turned down to bridge the gap, with the foot in plantigrade and augmented with flexor hallucis longus. The flexor hallucis longus was threaded through the distal stump and tenodesed and myodesed to the reconstructed Achilles tendon.

All patients were put in a non-weight bearing cast for 6 weeks followed by partial weight bearing, physiotherapy and strengthening exercises. There were no complications in our series. Six patients were available for assessment. At minimum of 2 years, AOFAS Score is 94.2, Ankle Hindfoot Visual Score of 0 in 5 and 5/10 in:

1. The SF 36 ranged from 75 to 96 for the various functions and patients rated the results from good to exellent with expectations of the surgery being met in most patients.

Reconstruction of Neglected Achilles Tendon Ruptures with a large gap are challenging. Methods proposed include transfers of various tendons, free grafts, allografts and synthetic materials. The gastrocnemius turn down flap with flexor hallucis longus augmentation can bridge a gap of 6–8cm with the foot in plantigrade. Rehabilitation can start after 6 weeks casting. The results show that most patients have achieved a good functional outcome and are satisfied to happy with the surgical outcome.