Acta Ortopédica Mexicana

Enríquez CJA, García HA, Pastrana F, López VA, González TA, Romo CFJ
Long-lasting untreated Achiles tendon ruptures. Plasty by a modified Christensen-Silverskjiold technique, without removing scarring fibrous tissue
Acta Ortop Mex 2002; 16 (3)

Language: Español
References: 32
Page: 119-123
PDF: 185.79 Kb.

[Fulltext - PDF]

ABSTRACT

Objective. Some 30% of Achiles-tendon rupture cases remain untreated. Our objective is to perform the reconstruction of the untreated late heel cord tears without removing the fibrous scar tissue which is developed in an atempt to spontaneously repair the tendon rupture, as it is realized that such a tissue preserves a high regenerative capacity. Material and methods. A group of 41 patients (25 male and 16 female) who had an average of 154 days (30 to 811) with an unrepaired achiles-tendon tears, were treated by reconstruction with a 10 to 12 cm flap of the gastrocnemius fascia over the remaining scar tissue which partially fills the hollow of 3 cm in average between the ends of the rupture, once a primary Bunnell unabsorbable suture was applied for shortening the distance between those ends. An immediate postoperative first equinus short limb cast is applied after surgery, which is removed at 3 weeks and changed by a second soleless cast with ankle at 90 degrees, in order to enhance free plantar extension as well as to avoid dorsal flexion, which must be beared to complete a 12-week span. A rehabilitation program must be acomplished afterwards. Results. After an average of 6 months, all patients were able to perform tip toes gait. With of the reconstructed tendon increased 8 mm in average in relationship to the opposite leg. Edema was present in 29 cases, which progressively disappeared in all. Superficial infection that appeared in 4 patients as the only complication, relieved with antibiotics and local wound care. Conclusion. Reconstruction of long-lasting heel cord injuries without removing spontaneous scar tissue is an affordable surgical procedure with standard good results.


Key words: Achiles-tendon, injury, reconstruction, gastrocnemius.


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