V-Y Tendon Plasty for Reconstruction of Chronic Achilles Tendon Rupture: A Medium-term and Long-term Follow-up.

OBJECTIVE: To evaluate the surgical results of V-Y tendon plasty in the treatment of chronic Achilles tendon rupture during medium and long-term follow-up.

METHODS: Between June 2005 and September 2017, 20 patients with chronic Achilles tendon rupture underwent V-Y tendon plasty in our hospital. The mean injury-to-surgery time was 20.4 weeks (range, 4-96 weeks). The Matles test and an improved Thompson test was used to examine Achilles tendon rupture. These patients were not able to stand on the tiptoes of the injured lower extremity. X-ray tests ruled out the chance of fracture and were used to examine the Kager triangle. MRI was used to confirm the final diagnosis. The function of the ankle and the foot was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Achilles Tendon Total Rupture Score (ATRS). V-Y tendon plasty for Achilles tendon reconstruction was performed. A below-knee cast was used to keep the ankle in plantar flexion (up to 20°) for 4 weeks. Non-weight-bearing exercise was allowed with crutches. After 4 weeks, partial weight-bearing was allowed. Physical exercises were performed under rehabilitation guidelines. At 10-12 weeks postoperation, patients began to return to daily life activity levels without restrictions. Preoperative and postoperative MRI was obtained.

RESULTS: The mean follow-up period was 32.8 months. The mean operative gap of the Achilles tendon after debridement was 5 cm (range, 4-9 cm), with 85% of the gap less than or equal to 6 cm. The mean AOFAS score increased from 59.25 ± 12.28 preoperatively to 96.55 ± 3.75 at final follow-up (P < 0.05). The mean ATRS score increased from 39.55 ± 14.21 preoperatively to 94.05 ± 4.89 at final follow-up (P < 0.05). All patients had no recurrent Achilles tendon rupture during the follow up. No patient had developed serious complications, such as sural nerve injury or deep vein thrombosis. Patients were able to return to daily life activity levels without restrictions. At the latest follow-up, all patients were able to perform repetitive single heel rise on the involved limb, and to walk without a visible limp. All of the postoperative MRI showed the continuity of the Achilles tendon with no signs of cysts or inflammation, indicating perfect healing at the final follow-up.

CONCLUSIONS: V-Y tendon plasty can be used in most cases of chronic Achilles tendon rupture. It yields satisfactory functional results and low complication rates. The advantage of this procedure is that it is an easy and economic method without the need for expensive synthetic implants. V-Y tendon plasty should be considered an acceptable first-choice treatment.