Treatment of chronic Achilles tendon rupture by shortening suture and free sural triceps aponeurosis graft
| Autor: | E. Sariali, Yves Catonné, E. Rolland, M. Di Schino, F. Khiami, D. Cao |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Reconstructive surgery AOFAS score Tendon Transfer Physical examination Achilles Tendon Free Tissue Flaps Risk Assessment Cohort Studies Injury Severity Score Postoperative Complications Tendon Injuries Humans Medicine Orthopedic Procedures Aponeurosis Orthopedics and Sports Medicine Muscle Skeletal Aged Retrospective Studies Ultrasonography Rupture Achilles tendon medicine.diagnostic_test business.industry Graft Survival Suture Techniques Age Factors Retrospective cohort study Recovery of Function Middle Aged Magnetic Resonance Imaging Surgery Tendon Treatment Outcome medicine.anatomical_structure Neglected rupture Chronic Disease Female Achilles tendon rupture medicine.symptom business Complication Follow-Up Studies |
| Zdroj: | Orthopaedics & Traumatology: Surgery & Research. 99(5):585-591 |
| ISSN: | 1877-0568 |
| DOI: | 10.1016/j.otsr.2013.03.021 |
| Popis: | Summary Introduction The Bosworth technique is old but still widely used. It involves problems of precisely determining the length of the Achilles tendon and of a volume effect in the turndown area. Hypothesis A new reconstruction technique is assessed, based on free sural triceps aponeurosis transfer without turndown, associated to tendon shortening suture. Materials and methods Twenty-three patients were assessed by AOFAS score and clinical examination (plus MRI in 14 cases) at a mean 24.5 months’ follow-up. Mean age was 52.1 years. Mean pre-operative AOFAS score was 63.6/100. Results Mean postoperative AOFAS score was 96.1. Mean graft length was 7.5 cm. Surgical revision was required for one case of postoperative infection. Twelve patients resumed leisure sports at their previous level by a mean 9.4 ± 2 months; three competitive sportsmen resumed sport at their previous level by a mean 7.6 months. None were dissatisfied or disappointed with their operation. MRI performed at 1 year found increased tendon volume without abnormality in 57% of cases; 43% showed abnormal images. Discussion Functional results were comparable to literature reports. It can be difficult to determine Achilles length for the Bosworth technique: this is made easier by conserving a fibrous support of a length determined with reference to the healthy side. The technique avoids aponeurosis turndown, and thus avoids the problem of plasty volume effect. The two cases of cutaneous complication occurred in the two most elderly patients, raising the question of the indications for reconstructive surgery in the elderly. The abnormalities found on MRI concerned scar tissue remodeling in patients with good or excellent clinical results. Level of evidence Level IV, retrospective study. |
| Databáze: | OpenAIRE |
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