J Korean Foot Ankle Soc.  2024 Mar;28(1):15-20. 10.14193/jkfas.2024.28.1.15.

Surgical Outcome of Achilles Reconstruction Using Allotendon and a Calcaneal Tunneling Technique in Patients with Chronic Achilles Rupture

• Kim GL
• Hong SY
• Cho JH
• Yoon TY

• KMID: 2553804
• DOI: http://doi.org/10.14193/jkfas.2024.28.1.15

Abstract

Purpose
Achilles tendon rupture is a frequently encountered ankle pathology associated with a substantial burden of intense pain and functional deficits. Chronic Achilles tendon ruptures with considerable defects pose intricate repair challenges that are often marred by complications such as re-rupture and persistent pain. Various treatment methods, including allograft transplantation, have been proposed, but the literature on this technique is limited. In this study, we propose a surgical approach utilizing allotendon transplantation and a calcaneal tunneling technique and provide clinical evaluation details.
Materials and Methods
Fifteen patients with chronic Achilles tendon ruptures treated with allotendon between 2020 and 2022 were included in the study. Patients were evaluated at 1, 3, and 6 months postoperatively using Visual Analog Scale (VAS) scores and Achilles Tendon Total Rupture Scores (ATRSs). Complications were assessed postoperatively.
Results
The average VAS score was 7 before surgery, 7.3 immediately after surgery, and 4.3 at 1 month, 2.5 at 3 months, and 1.3 at 6 months after surgery. Because the sample was limited to 15 individuals and distributions were non-normal, the analysis was conducted using the non-parametric Wilcoxon’s signed-rank test, and statistical significance was accepted for p-values<0.05. Results showed a significant improvement in ATRS and VAS scores versus preoperative and immediate postoperative values. VAS scores showed a decreasing trend after surgery, whereas average ATRS scores increased from 14 before surgery, 33.8 at 1 month, 82.7 at 3 months, and 93.9 at 6 months.
Conclusion
This study suggests that allograft transplantation using the described calcaneal tunnel technique provides an effective treatment for chronic Achilles tendon ruptures. However, extensive research and long-term clinical trials are required to validate and better understand the technique’s efficacy.

Keyword

Chronic Achilles tendon rupture; Bone tunnel; Fish mouth technique

Figure

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  Figure 1 The bone tunnel is made on 1.5 cm anterior from the achilles tendon attachment site.

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  Figure 2 Folded Kirschner wire is passed through the bone tunnel for inserting the allotendon.

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  Figure 3 Allotendon crossing over each other using the "Fish-mouth technique". (A) Tunnel is created in the proximal part of the Achilles tendon for the allotendon to pass through with an 11-blade. (B) To maintain appropriate tension of the allotendon, it is secured using Kelly forceps.

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  Figure 4 The allotendon is fastened to the proximal end of the ruptured Achilles tendon using Ethibond.

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  Figure 5 A schematic diagram that illustrates the artistic process.

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  Figure 6 Wound necrosis occurred at the surgical incision site.

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