Introduction: Neglected Achilles tendon ruptures are a management challenge. Several surgical techniques have been described. A two centre, two surgeon, two year longitudinal study was undertaken to report the results of reconstruction of neglected Achilles tendon rupture using a free autologous gracilis tendon graft

Methods: Fourteen patients underwent surgery for a neglected rupture of the Achilles tendon occurring between 65 days and nine months before the operation. All were prospectively followed up for two years.

Results: No patients experienced any problems in the wound used to harvest the tendon of gracilis. Four patients were managed conservatively following a superficial infection of the achilles tendon surgical wound. No patients developed a deep vein thrombosis or sustained a re-rupture. All patients were able to walk on tiptoes, and no patient used a heel raise or walked with a visible limp. The maximum calf circumference remained significantly decreased in the operated leg at latest follow up. The operated limb was significantly less strong than the non-operated one.

Conclusions: The management of neglected subcutaneous tears of the Achilles tendon by free gracilis tendon grafting is safe but technically demanding. It affords good recovery, even in patients with a neglected rupture of nine months’ duration. These patients should be warned that they are at risk of post-operative complications, and that their ankle plantar flexion strength can remain reduced.