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ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2002, Number 3

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Acta Ortop Mex 2002; 16 (3)

Long-lasting untreated Achiles tendon ruptures. Plasty by a modified Christensen-Silverskjiold technique, without removing scarring fibrous tissue

Enríquez CJA, García HA, Pastrana F, López VA, González TA, Romo CFJ

Language: Spanish
References: 32
Page: 119-123
PDF size: 185.79 Kb.


ABSTRACT

Objective. Some 30% of Achiles-tendon rupture cases remain untreated. Our objective is to perform the reconstruction of the untreated late heel cord tears without removing the fibrous scar tissue which is developed in an atempt to spontaneously repair the tendon rupture, as it is realized that such a tissue preserves a high regenerative capacity. Material and methods. A group of 41 patients (25 male and 16 female) who had an average of 154 days (30 to 811) with an unrepaired achiles-tendon tears, were treated by reconstruction with a 10 to 12 cm flap of the gastrocnemius fascia over the remaining scar tissue which partially fills the hollow of 3 cm in average between the ends of the rupture, once a primary Bunnell unabsorbable suture was applied for shortening the distance between those ends. An immediate postoperative first equinus short limb cast is applied after surgery, which is removed at 3 weeks and changed by a second soleless cast with ankle at 90 degrees, in order to enhance free plantar extension as well as to avoid dorsal flexion, which must be beared to complete a 12-week span. A rehabilitation program must be acomplished afterwards. Results. After an average of 6 months, all patients were able to perform tip toes gait. With of the reconstructed tendon increased 8 mm in average in relationship to the opposite leg. Edema was present in 29 cases, which progressively disappeared in all. Superficial infection that appeared in 4 patients as the only complication, relieved with antibiotics and local wound care. Conclusion. Reconstruction of long-lasting heel cord injuries without removing spontaneous scar tissue is an affordable surgical procedure with standard good results.


REFERENCES

  1. Abraham Edward, Arsen M Pankovich. Neglected rupture of the Achilles tendon. J Bone Joint Surg 1975; 57A(2): 253-5.

  2. Aracil J, Pina A, Lozano JA, Torro V, Escriba I. Percutaneous suture of Achilles tendon ruptures. Foot & Ankle 1992; 13(6): 350-1.

  3. Bugg EI, Boyd BM. Repair of neglected rupture or laceration of the Achilles tendon. Clin Orthop Rel Res 1968; 56: 73-4.

  4. Calderón Ramírez De Aguilar F. Tratamiento quirúrgico de las rupturas inveteradas del tendón de Aquiles con la técnica de Lindholm modificada. An Ortop Trauma Méx 1974; 10(4): 291-303.

  5. Carr AJ, Norris SH. The blood supply of the calcaneal tendon. J Bone Joint Surg 1989; 71B(1): 100-1.

  6. Christensen RE. To tilfaelde af Achillesseneruptur. Dansk Kir. Selsk Forh 1931: 39.

  7. Christensen IB. Rupture of the Achilles tendon analysis of 57 cases. Act Chirurg Scand 1953; 106: 50-60.

  8. De la Fuente NV. Reparación de la ruptura del tendón de Aquiles. An Ortop Traum Méx 1973; 9(2): 83-90.

  9. Fox JM, Blazina ME, Jobe FW, Kerlan RK, Carter VS, Shields CL, Carlson GJ. Degeneration and rupture of the Achilles tendon. Clin Orthop Rel Res 1975; 107: 221-4.

  10. Gabel S, Manoli A. Neglected rupture of Achillis tendon. Foot & Ankle Int 1994; 15(9): 512-7.

  11. Gerdes MH, Brown TD, Bell AL, Baker JA, Levson M, Layer S. Clin Orthop Rel Res 1992; 280: 241-6.

  12. Gilles H, Chalmers J. The management of fresh ruptures of the tendon Achilles. J Bone Joint Surg 1970; 52(2): 337-43.

  13. Hattrup SJ, Johnson KA. A review or ruptures in the Achilles tendon. Foot & Ankle 1985; 6(1): 34-8.

  14. Hooker CH, Hamilton. Rupture of the tendon calcaneus. J Bone Joint Surg 1963; 45B(2): 360-3.

  15. Howard CB, Winston I, Bell W, Mackie I, Jenkins HR. Late repair of the calcaneal tendon with carbon fibre. J Bone Joint Surg 1984; 66B(2): 206-8.

  16. Inglis AE, Scott N, Sculco TP, Patterson AH. Ruptures of the tendon Achillis. An objective assessment of surgical and non-surgical treatment. J Bone Joint Surg 1976; 58A(7): 990-3.

  17. Jenkins; Foster IW, McKibbin B, Raliz, Cardiff, Wales. Induction of tendon and ligament formation by carbon implants. J Bone Joint Surg 1997; 59B(1): 53-7.

  18. Kato YP, Dunn MG, Zawadsky JP, Tria AJ, Silver FH. Regeneration of Achilles tendon with a collagen tendon prosthesis. J Bone Joint Surg 1991; 73A(4): 561-74.

  19. Kellam JF, Hunter GA, McElwain JP. Review of the operative treatment of Achillis tendon rupture. Clin Orthop Rel Res 1985; 201: 80-3.

  20. Lagergren C, Lindholm Ake. Vascular distribution in the Achilles tendon. An angiographic and microangiographic study. Acta Chir Scandinav 1959; 116:5(6): 491-5.

  21. Lea RB, Smith L. Non surgical treatment of tendon Achillis rupture. J Bone Joint Surg 1972; 54A(7): 1398-1407.

  22. Leitner A, Voigt Ch, Rahmanzadeh R. Treatment of extensive aseptic defects in old Achilles tendon ruptures: Methods and case reports. Foot & Ankle 1992; 13(4): 176-80.

  23. Levy M, Velkes S, Goldstein J, Rosner M. A method or repair for Achilles tendon ruptures without cast immobilization. Clin Orthop Rel Res 1984; 187: 199-204.

  24. Lieberman JR, Lozman J, Czajka J, Dougherty J. Repair of Achilles tendon ruptures with dacron vascular graft. Clin Orthop Rel Res 1988; 234: 204-8.

  25. Lindholm Ake. A new method of operation in subcutaneous rupture of the Achilles tendon. Acta Chir Scand 1959; 117: 261.

  26. Lynn TA. Repair on the torn Achillis tendon, using the plantaris tendon as a reinforcing membrane. J Bone Joint Surg 1966; 48-A(2): 268-72.

  27. Mann RA, Holmes GB Jr, Seale Karen S, Collins David N. Chronic rupture of the Achilles tendon: A new technique of repair. J Bone Joint Surg 1991; 73A(1): 214-9.

  28. Nistor Lars. Surgical and non surgical treatment of Achilles tendon rupture. J Bone Joint Surg 1981; 63A(3): 394-9.

  29. Saillant G, Thoreux P, Benzaet JP, Roy Camille R. Patología del tendón de Aquiles. Enciclopedia Médico-Quirúrgica. 14:795.

  30. Solares R, Cabral RS. Ruptura no reciente del tendón de Aquiles. Reparación con plastía aponeurótica del tríceps. Semana Médica de México 1985: 199-206.

  31. Thompson CT. A test rupture of the tendon rupture. J Trauma 1962;

  32. Wapner Keith L, Pavlock Gail S, Hecht Paul J, Naselli Francis, Walther Robyn. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot & Ankle 1993; 14(8): 443-9.




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