Foot & Ankle International - July 2016 - (Page 737)

642753 FAIXXX10.1177/1071100716642753Foot & Ankle InternationalGuclu et al research-article2016 Article Long-term Results of Chronic Achilles Tendon Ruptures Repaired With V-Y Tendon Plasty and Fascia Turndown Foot & Ankle International® 2016, Vol. 37(7) 737-742 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100716642753 fai.sagepub.com Berk Guclu, MD1, H. Cagdas Basat, MD2, Tugrul Yildirim, MD3, Omer Bozduman, MD1, and Ali Kemal Us, MD4 Abstract Background: This study aimed to evaluate the long-term follow-up results of V-Y tendon plasty with fascia turndown, for repairing chronic Achilles tendon ruptures. Methods: Seventeen patients (12 males, 5 females), who were diagnosed with chronic Achilles tendon rupture and met the inclusion criteria, were included in the study. These patients received treatment by means of V-Y tendon plasty with fascia turndown from January 1995 to December 2001. Clinical outcomes of the patients were assessed by using isokinetic strength testing, questioning the patient regarding residual discomfort, pain, or swelling and having the ability to perform heel rises and using American Orthopaedic Foot & Ankle Society's (AOFAS's) Ankle-Hind Foot Scale score. Mean followup duration was 16 years (13-18 years). Results: Mean time from the injury to operative treatment was 7 months. Mean operative defect of Achilles tendon in neutral position after debridement was 6 cm. During the follow-up, the mean calf atrophy was 3.4 cm. The mean 30 degrees/s plantarflex and 120 degrees/s plantarflex peak torques were 89 and 45 Nm, respectively. The mean 30 degrees/s plantarflex peak torque deficiency was 16%. The mean 120 degrees/s plantarflex peak torque deficiency was 17%. The average peak torque deficiency was 17%. The pre- and postoperative mean AOFAS Ankle-Hindfoot Scale scores were 64 and 95, respectively. No patient had a rerupture. Superficial wound infection was treated with oral antibiotic therapy in 2 patients (11%). Conclusions: The V-Y tendon plasty with fascia turndown for repairing chronic Achilles tendon ruptures yielded results comparable with the literature regarding clinical outcomes. This method did not require synthetic materials for augmentation and was an economic alternative compared to other repair methods. Level of Evidence: Level III, retrospective comparative study. Keywords: chronic Achilles tendon tear, Achilles tendon reconstruction, neglected rupture Introduction Chronic Achilles tendon rupture is a challenging condition to treat. Delay in treatment causes the tendinous ends to retract and atrophy, leaving a wide separation that becomes occupied with fibro-adipose scar tissue. After excising the intervening scar tissue, it is difficult to perform end-to-end repair.9,25 Patients with a chronic Achilles tendon rupture have a greater tendency to develop complications and poorer functional results than patients with a fresh rupture.14,22 The role of operative and nonoperative treatment in acute ruptures continues to be debated, but some investigators agree that chronic ruptures should be treated operatively unless there are contraindications for surgery or the patient has minimal functional demands.14,20 The aim of surgery is to restore and maintain the length of the Achilles tendon to achieve propulsive gait by the gastrocsoleus muscle complex.17,27 Nonoperative treatment should be used for patients who have minimal functional demands, poor healing capacity, high medical morbidity such as uncontrolled diabetes mellitus, or vascular disease; however, increased rerupture rates and decreased functional results are seen with nonoperative 1 Department of Orthopedic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkey 2 Department of Orthopedic Surgery, Koru Hospital, Çukurambar, Ankara, Turkey 3 Department of Orthopedic Surgery, Kazan Hamdi Eris State Hospital, Ankara, Turkey 4 Department of Orthopedic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey Corresponding Author: Tugrul Yildirim, MD, Department of Orthopedic Surgery, Kazan Hamdi Eris State Hospital, Kazan, Ankara, Turkey. Email: mdtugrul@hotmail.com http://www.sagepub.com/journalsPermissions.nav http://fai.sagepub.com

Table of Contents for the Digital Edition of Foot & Ankle International - July 2016

TOC/TOC/Verso
Editorial Board
Advertiser Index
Long Term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction
Clinical Outcome and Fusion Rate following Simultaneous Subtalar Fusion and Total Ankle Arthoplasty
Anterior Heterotopic Ossification at the Talar Neck After Total Ankle Arthroplasty
Secondary Arthrodesis After Total Ankle Arthroplasty
Functional Outcomes Following First Metatarsophalangeal Arthrodesis
Increased Reduction Clamp Force Associated With Syndesmotic Overcompression
Pain Threshold Tests in Patients With Heel Pain Syndrome
Long-term Results of Chronic Achilles Tendon Ruptures With V-Y Tendon Plasty and Fascia Turndown
Peroneal Tendon Abnormalities on Routine Magnetic Resonance Imaging of the Foot and Ankle
Incisura Morphology as a Risk Factor for Syndesmotic Malreduction
Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux
Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for Achilles Tendinopathy
Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act
Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia
Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia: A Prospective Study of 78 Cases.
Response to "Letter Regarding: Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia"
The Internal Brace for Midsubstance Achilles Ruptures
The Evolution of Patient Safety
Education Calendar
Foot & Ankle International - July 2016

Foot & Ankle International - July 2016