Objective: To evaluate the effectiveness of hamstring tendon and flexor hallucis longus (FHL) tendon autograft for Achilles tendon defects reconstruction.
Methods: Between February 2009 and October 2011, 9 patients (9 feet) with Achilles tendon defect were treated with hamstring tendon and FHL tendon autograft. Of 9 cases, 6 were male and 3 were female with an average age of 43 years (range, 21-65 years), including 5 cases of chronic Achilles tendon ruptures caused by sport injury and 4 cases of Achilles tendon defects caused by resection of tendon lesion (2 cases of hyaline degeneration with necrosis, 1 case of giant cell tumor, and 1 case of chronic inflammation with hyaline degeneration). The disease duration ranged from 31 to 387 days (mean, 137.6 days). The defect length was 5 to 18 cm (mean, 8.6 cm). Functional exercise of the ankle began at 6 weeks after plaster fixation.
Results: Dehiscence and effusion occurred in 2 cases and plantar pain caused by injury of tibial nerve in 1 case; primary healing of wound was obtained in the other patients without complication. Nine patients were followed up 19.7 months on average (range, 13-25 months); no re-rupture was observed. There was no significant difference in the dorsal extension between at preoperation and at 1 year and last follow-up after operation (P > 0.05); the ankle plantar flexion at 1 year and last follow-up after operation was significantly larger than that at preoperation (P < 0.05). The ankle plantar flexion and dorsal extension at 1 year and last follow-up after operation were significantly larger than those at 3 months after operation (P < 0.05), but no significant difference was found between at 1 year and last follow-up (P > 0.05). American Orthopaedic Foot and Ankle Society (AOFAS) and short-form 36 health survey scale (SF-36) scores were significantly increased at postoperation when compared with scores at preoperation (P < 0.05), and the scores at last follow-up were significantly higher than those at 3 months after operation (P < 0.05). The Achilles tendon total rupture score (ATRS) at last follow-up was significantly higher than that at 3 months after operation (t = -7.982, P = 0.000).
Conclusion: Combined hamstring tendon and FHL tendon autograft is one of the effect methods to reconstruction Achilles tendon defects.