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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Management of chronic tendon rupture is a demanding task due to the presence of tendon retraction, muscle atrophy, and skin contracture that is frequently present around the tendon (1)

Conservative management

  • can be attempted in patients who refuse surgery or are contraindicated
  • brace or ankle-foot orthosis can be used
  • in a series of fifty-one patients with fifty seven ruptures (out of which nearly two-thirds were chronic ruptures) eighteen were treated conservatively
    • satisfactory results were seen in ten of these eighteen patients e.g. - the gait was normal, the patient returned to his or her previous occupation, and there was slight or no discomfort)
    • recovery time of these patients were long sometimes over several years
    • however the results were poor when compared to patients who were managed surgically (1,2)

Surgical management

  • optimal technique for treating chronic Achilles tendon rupture is controversial. Operative procedures for treatment of chronic rupture include:
    • end to end anastamosis
    • flap tissue turn down using one and two flaps
      • V-Y advancement flap - anastomosis of the tendon ends is achieved by making an inverted V-shaped incision in the proximal part of the tendon and repairing it in a Y-shaped fashion
      • gastrocnemius fascial turndown flap
    • local tendon transfer
      • peroneus Brevis tendon transfer
      • flexor halluces longus tendon (FHLT) transfer
    • autologous free tendon grafts
      • gracilis tendon
    • allografts (1,2)
  • according to the length of the defect, two classification systems have been proposed for the surgical management of the condition
    • Myerson’s classification
      • type-1 defect is no more than 1 to 2 cm long - managed with end-to-end repair and a posterior compartment fasciotomy
      • type-2 defect ranges between 2 and 5 cm - managed with V-Y lengthening, with or without a tendon transfer
      • type-3 defect is >5 cm - bridged with use of a tendon transfer, alone or in combination with a V-Y advancement (1,2)

Reference:

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