Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts are effective in the treatment of chronic Achilles tendon ruptures - a systematic review

Niklas Nilsson; Immanuel Stensöta; Katarina Nilsson Helander; Annelie Brorsson; Michael R Carmont; Sebastian Concaro

doi:10.1186/s12891-023-07064-8

Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts are effective in the treatment of chronic Achilles tendon ruptures - a systematic review

BMC Musculoskelet Disord. 2023 Dec 8;24(1):951. doi: 10.1186/s12891-023-07064-8.

Authors

Niklas Nilsson^{1

2}, Immanuel Stensöta^{3

4}, Katarina Nilsson Helander^{3

4}, Annelie Brorsson^{3

5}, Michael R Carmont^{3

6}, Sebastian Concaro^{3

4}

Affiliations

¹ Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. niklas.nilsson@vgregion.se.
² Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, 431 80, Sweden. niklas.nilsson@vgregion.se.
³ Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁴ Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, 431 80, Sweden.
⁵ IFK Kliniken Rehab, Gothenburg, Sweden.
⁶ Department of Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust, Shropshire, UK.

Abstract

Introduction: A chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to summarize the outcomes of chronic ATR treated using either a gastrocnemius aponeurosis flap or semitendinosus tendon graft.

Methods: A systematic search was conducted in three databases (PubMed, Scopus and Cochrane), for studies describing outcomes after surgical treatment of chronic ATR using gastrocnemius aponeurosis flaps or semitendinosus tendon grafts with more than 10 patients included. The studies were assessed for quality and risk of bias using the Methodological Items used to assess risk of bias in Non-Randomized Studies (MINORS).

Results: Out of the 818 studies identified with the initial search, a total of 36 studies with 763 individual patients were included in this systematic review. Gastrocnemius aponeurosis flap was used in 21 and semitendinosus tendon graft was used in 13 of the studies. The mean (SD) postoperative Achilles tendon Total Rupture Score (ATRS) for patients treated with a gastrocnemius aponeurosis flap was 83 (14) points and the mean (SD) American Orthopaedic Foot and Ankle Score (AOFAS) was 96 (1.7) points compared with ATRS 88 (6.9) points and AOFAS 92 (5.6) points for patients treated with a semitendinosus tendon graft. The included studies generally had low-quality according to MINORS, with a median of 8 (range 2-13) for all studies.

Conclusion: Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts give acceptable results with minimal complications and are valid methods for treating chronic ATR. The main difference is more wound healing complications in patients treated with a gastrocnemius aponeurosis flap and more sural nerve injuries in patients treated with a semitendinosus grafts. The current literature on the subject is of mainly low quality and the absence of a patient-related outcome measure validated for chronic ATR makes comparisons between studies difficult.

Level of evidence: Level IV.

Keywords: Chronic Achilles tendon rupture; Gastrocnemius aponeurosis flap; MINORS; Semitendinosus tendon graft; Surgical repair; Systematic review.

Publication types

Systematic Review

MeSH terms

Achilles Tendon* / injuries
Achilles Tendon* / surgery
Aponeurosis
Hamstring Tendons*
Humans
Muscle, Skeletal / transplantation
Rupture / surgery
Surgical Flaps
Tendon Injuries* / surgery
Treatment Outcome