Use of a Non-Crosslinked Porcine Dermal Matrix in Repair of the Achilles and Other Tendons of the Foot

Case Series Report: Reconstruction of Chronic Achilles Tendon Rupture With Semitendinosus Autograft Combined With Vulpius Technique

We present five patients with chronic ruptures of the Achilles tendon and a defect larger than 6 cm. The average age of patients was 47 years. The interval between the rupture and treatment was between two and seven months. The size of the defects was between 6 and 12 cm, determined by magnetic resonance imaging (MRI) and/or ultrasound. All patients had an inability to step on the patient's limbs, a positive Thompson's symptom, difficulty walking and calf atrophy. Here, we evaluated the surgical results of semitendinosus autograft combined with Vulpius lengthening of the gastrocnemius in the treatment of chronic Achilles tendon rupture with a defect larger than 6 cm during medium-term follow-up.

Microfragmented Adipose Tissue (M-FATS) for Improved Healing of Surgically Repaired Achilles Tendon Tears: A Preliminary Study

INTRODUCTION

Tendon healing is a complicated process that results in inferior structural and functional properties when compared with healthy tendon; the purpose of this study was to assess the effects of the adjunct of microfragmented adipose tissue (M-FATS) after the suture of a series of Achilles tendons.

METHODS

After complete Achilles tendon tear, 8 patients underwent open suture repair in conjunction with perilesional application of a preparation of M-FATS rich in mesenchymal stem cells. Results were compared with a similar group of patients treated with conventional open suture. Outcomes were evaluated based on range of motion, functional recovery, and complications according to the American Orthopedic Foot and Ankle Society (AOFAS) score and Foot and Ankle Disability Index (FADI). Achilles tendons were examined by ultrasound (US) at 3 months.

RESULTS

The AOFAS and FADI scores showed no differences between the 2 groups. US evaluation showed quicker tendon remodeling in the M-FATS group. Adverse events were not documented for both procedures.

CONCLUSIONS

The combined application of derived M-FATS for tendon rupture is safe and presents new possibilities for enhanced healing.

LEVELS OF EVIDENCE

Level IIIb: Case control study.

V-Y Tendon Plasty for Reconstruction of Chronic Achilles Tendon Rupture: A Medium-term and Long-term Follow-up

Objective

To evaluate the surgical results of V‐Y tendon plasty in the treatment of chronic Achilles tendon rupture during medium and long‐term follow‐up.

Methods

Between June 2005 and September 2017, 20 patients with chronic Achilles tendon rupture underwent V‐Y tendon plasty in our hospital. The mean injury‐to‐surgery time was 20.4 weeks (range, 4–96 weeks). The Matles test and an improved Thompson test was used to examine Achilles tendon rupture. These patients were not able to stand on the tiptoes of the injured lower extremity. X‐ray tests ruled out the chance of fracture and were used to examine the Kager triangle. MRI was used to confirm the final diagnosis. The function of the ankle and the foot was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Achilles Tendon Total Rupture Score (ATRS). V‐Y tendon plasty for Achilles tendon reconstruction was performed. A below‐knee cast was used to keep the ankle in plantar flexion (up to 20°) for 4 weeks. Non‐weight‐bearing exercise was allowed with crutches. After 4 weeks, partial weight‐bearing was allowed. Physical exercises were performed under rehabilitation guidelines. At 10–12 weeks postoperation, patients began to return to daily life activity levels without restrictions. Preoperative and postoperative MRI was obtained.

Results

The mean follow‐up period was 32.8 months. The mean operative gap of the Achilles tendon after debridement was 5 cm (range, 4–9 cm), with 85% of the gap less than or equal to 6 cm. The mean AOFAS score increased from 59.25 ± 12.28 preoperatively to 96.55 ± 3.75 at final follow‐up (P < 0.05). The mean ATRS score increased from 39.55 ± 14.21 preoperatively to 94.05 ± 4.89 at final follow‐up (P < 0.05). All patients had no recurrent Achilles tendon rupture during the follow up. No patient had developed serious complications, such as sural nerve injury or deep vein thrombosis. Patients were able to return to daily life activity levels without restrictions. At the latest follow‐up, all patients were able to perform repetitive single heel rise on the involved limb, and to walk without a visible limp. All of the postoperative MRI showed the continuity of the Achilles tendon with no signs of cysts or inflammation, indicating perfect healing at the final follow‐up.

Conclusions

V‐Y tendon plasty can be used in most cases of chronic Achilles tendon rupture. It yields satisfactory functional results and low complication rates. The advantage of this procedure is that it is an easy and economic method without the need for expensive synthetic implants. V‐Y tendon plasty should be considered an acceptable first‐choice treatment.