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      Chronic Achilles Tendon Rupture

      review-article

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          Abstract

          Background:

          The Achilles tendon, the largest and strongest tendon in the human body, is nevertheless one of the tendons which most commonly undergoes a complete subcutaneous tear. Achilles tendon ruptures are especially common in middle aged men who occasionally participate in sport. Even though Achilles tendon ruptures are frequent, up to 25% of acute injuries are misdiagnosed, and present as chronic injuries.

          Methods:

          This is a review article about diagnosis and management of chronic Achilles tendon ruptures. Minimally invasive Achilles tendon reconstruction is discussed.

          Results:

          The optimal surgical procedure is still debated, however, less invasive peroneus brevis reconstruction technique and free hamstring autograft provide good functional results.

          Conclusion:

          The management of chronic ruptures is more demanding than acute tears, because of the retraction of the tendon ends, and the gap makes primary repair impossible. Wound complications and infections are frequent after open procedures. Minimally invasive treatments provide good functional results and lower complications rate.

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          Most cited references25

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          Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer.

          A new technique is described for reconstruction of chronic Achilles tendon rupture using the flexor hallucis longus tendon. Follow-up on seven patients (mean age 52 years) is provided (average follow-up 17 months, range 3-30 months). All patients were re-examined to assess postoperative range of motion, scar healing, and sensation. Motor strength was assessed by Cybex testing. Subjective satisfaction was examined by completion of a questionnaire. There were no postoperative infections, skin losses, or re-ruptures. Each patient developed a small but functionally insignificant loss in range of motion in the involved ankle and great toe. All patients had a satisfactory return of function. One patient required a molded foot-ankle orthosis for extended ambulation but was able to play golf.
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            Rupture of the Achilles tendon.

            N Maffulli (1999)
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              Chronic Achilles Tendon Disorders

              Tendinopathy of the Achilles tendon involves clinical conditions in and around the tendon and it is the result of a failure of a chronic healing response. Although several conservative therapeutic options have been proposed, few of them are supported by randomized controlled trials. The management is primarily conservative and many patients respond well to conservative measures. If clinical conditions do not improve after 6 months of conservative management, surgery is recommended. The management of chronic ruptures is different from that of acute ruptures. The optimal surgical procedure is still debated. In this article chronic Achilles tendon disorders are debated and evidence-based medicine treatment strategies are discussed.
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                Author and article information

                Journal
                Open Orthop J
                Open Orthop J
                TOORTHJ
                The Open Orthopaedics Journal
                Bentham Open
                1874-3250
                31 July 2017
                2017
                : 11
                : 660-669
                Affiliations
                [1 ]Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy
                [2 ]Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England
                [3 ]Department of Orthopaedic and Traumatology, University of Rome “Tor Vergata”, School of Medicine, Viale Oxford 81, 00133 Rome, Italy
                Author notes
                [* ]Address correspondence to this author at the Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England; Tel: +44 7989 358 279; E-mail: n.maffulli@ 123456qmul.ac.uk
                Article
                TOORTHJ-11-660
                10.2174/1874325001711010660
                5633724
                29081863
                31fb63a5-e98f-41a5-91b8-9ecf6213bf0b
                © 2017 Maffulli et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 February 2016
                : 16 July 2016
                : 23 July 2016
                Categories
                Article
                Suppl-4, M6

                Orthopedics
                achilles tendon,chronic ruptures,minimally-invasive surgery,neglected injury,tendon ruptures,tendon transfer

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