Endoscopic-assisted achilles tendon reconstruction with free hamstring tendon autograft for chronic rupture of achilles tendon: clinical and isokinetic evaluation

Ossama El Shazly; Maged M Abou El Soud; Dalia M E El Mikkawy; Ibrahim El Ganzoury; Ayman Mohamed Ibrahim

doi:10.1016/j.arthro.2014.02.019

Endoscopic-assisted achilles tendon reconstruction with free hamstring tendon autograft for chronic rupture of achilles tendon: clinical and isokinetic evaluation

Arthroscopy. 2014 May;30(5):622-8. doi: 10.1016/j.arthro.2014.02.019.

Authors

Ossama El Shazly¹, Maged M Abou El Soud², Dalia M E El Mikkawy³, Ibrahim El Ganzoury², Ayman Mohamed Ibrahim⁴

Affiliations

¹ Orthopedic Department, Ain Shams University, Cairo, Egypt. Electronic address: ossama_elshazly@yahoo.com.
² Orthopedic Department, Ain Shams University, Cairo, Egypt.
³ Department of Physical Medicine, Rheumatology, and Rehabilitation, Ain Shams University, Cairo, Egypt.
⁴ Radiology Department, Ain Shams University, Cairo, Egypt.

PMID: 24725316
DOI: 10.1016/j.arthro.2014.02.019

Abstract

Purpose: To evaluate the clinical and functional outcome of endoscopic-assisted reconstruction of chronic ruptures of the Achilles tendon using free hamstring tendon autograft.

Methods: We present a case series of 15 patients who had chronic ruptures of the Achilles tendon (>6 weeks earlier) and underwent endoscopic-assisted reconstruction with a free hamstring autograft. The graft loop was passed through and fixed to the proximal stump of the tendon. The graft was then passed through suture to the distal stump and finally inserted into a tunnel in the anterior calcaneus to the Achilles tendon insertion and fixed with an bioabsorbable interference screw. The mean follow-up period was 27 months (SD, 3 months; range, 24 to 33 months). All patients underwent magnetic resonance imaging preoperatively, immediately postoperatively, and at follow-up 2 years postoperatively. All patients were functionally evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) score for the hindfoot preoperatively and postoperatively. Calf muscle power was evaluated by isokinetic strength testing at 2 years' follow-up.

Results: The mean size of the gap on preoperative magnetic resonance imaging was 49 mm (SD, 9 mm). The mean preoperative AOFAS score was 32.6 (SD, 7.5). There was a statistically significant improvement in the postoperative AOFAS score after 2 years to 90.8 (SD, 3.54) (P < .05). The mean time of return to all daily activities (except running and other sports) was 12.6 weeks (SD, 1.39 weeks). Isokinetic testing showed a nonsignificant deficit (<10%) between the involved and uninvolved plantar flexors and dorsiflexors with regard to peak torque, average power, and total work.

Conclusions: Endoscopic-assisted Achilles tendon reconstruction with free hamstring tendon autograft for chronic ruptures of the Achilles tendon showed good to excellent results in all patients. Isokinetic testing showed a nonsignificant deficit between the involved and uninvolved sides at 2 years' follow-up.

Level of evidence: Level IV, therapeutic cases series.

Publication types

Clinical Trial

MeSH terms

Achilles Tendon / pathology
Achilles Tendon / surgery*
Adult
Autografts
Chronic Disease
Endoscopy / methods*
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Orthopedic Procedures / methods*
Plastic Surgery Procedures / methods*
Prospective Studies
Rupture / surgery
Tendons / transplantation*
Transplantation, Autologous
Treatment Outcome