Achilles tendon ruptures, if neglected or identified late, lead to impairments in function and gait. Surgical reconstruction is typically required to restore the resting length and tension to the gastrocnemius-soleus complex. A variety of reconstructive options have been described, depending on several factors, including chronicity, residual gap size, remaining tissue quality and vascularity, location of tendon rupture or deficiency, and patient-specific factors. Despite the many surgical options described from local soft-tissue rearrangements and tendon transfers, to the use of allograft tissue and synthetic material augmentation, there is understandably a paucity of evidence-based guidelines available to direct surgeons in the optimal procedure for each patient-specific situation. Reconstructive options for the patient with a chronic Achilles rupture are detailed and reviewed here, to serve as a framework for the treating surgeon in these complex cases.
From the Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
Dr. Adams or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Sonoma Orthopaedics; serves as a paid consultant to 4web, MedShape, Regeneration Technologies, Sonoma Orthopaedics, and Stryker; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot and Ankle Society. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Schweitzer and Dr. Dekker.