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Free Gracilis Tendon Graft for Reconstruction of Chronic Tears of the Achilles Tendon

Maffulli, Nicola MD, MS, PhD, FRCS(Orth); Spiezia, Filippo MD; Testa, Vittorino MD; Capasso, Giovanni MD; Longo, Umile Giuseppe MD, MSc; Denaro, Vincenzo MD

Journal of Bone & Joint Surgery - American Volume: 16 May 2012 - Volume 94 - Issue 10 - p 906–910
doi: 10.2106/JBJS.K.00869
Scientific Articles

Background: Chronic tears of the Achilles tendon with a tendon gap exceeding 6 cm are a surgical challenge. The purpose of this study is to report the long-term results of reconstruction of such chronic Achilles tendon ruptures with use of a free autologous gracilis tendon graft.

Methods: Twenty-one patients underwent reconstruction of a chronic rupture of the Achilles tendon. Fifteen patients were available for clinical and functional assessment on the basis of anthropometric measurements, isometric strength testing, and the Achilles Tendon Total Rupture Score after a mean duration of follow-up of 10.9 years (range, eight to twelve years).

Results: All fifteen patients were able to walk on the tiptoes, and no patient used a heel lift or walked with a visible limp. At an average of 10.9 years of follow-up, the maximum calf circumference of the operatively treated leg remained substantially decreased and the operatively treated limb was significantly weaker than the contralateral, normal limb. Two patients had developed tendinopathy of the contralateral Achilles tendon, one had developed tendinopathy of the reconstructed tendon, and one had ruptured the contralateral Achilles tendon eight years after the index tear.

Conclusions: The long-term results of treatment of chronic tears of the Achilles tendon with free gracilis tendon grafting showed that patients retained good functional results despite permanently impaired ankle plantar flexion strength and decreased calf circumference.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England. E-mail address:

2Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.

3Department of Sports Medicine, Olympic Center, Via dei Goti 84012, Agri (SA), Italy

4Second University of Naples Medical School, First Institute of Orthopaedics, Via de Crecchio 4, 80100, Napoli, Italy

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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