We wish to report a technique for the reconstruction of the late presenting Achilles tendon 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 24 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 Achilles tendon ruptures, but great care is required with soft tissue dissection distally. Consideration could be given to deep flexor transfers in the widely separated case.