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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2023

Open Access 01-12-2023 | Achilles Tendon Rupture | Research

Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts are effective in the treatment of chronic Achilles tendon ruptures – a systematic review

Authors: Niklas Nilsson, Immanuel Stensöta, Katarina Nilsson Helander, Annelie Brorsson, Michael R. Carmont, Sebastian Concaro

Published in: BMC Musculoskeletal Disorders | Issue 1/2023

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Abstract

Introduction

A chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to summarize the outcomes of chronic ATR treated using either a gastrocnemius aponeurosis flap or semitendinosus tendon graft.

Methods

A systematic search was conducted in three databases (PubMed, Scopus and Cochrane), for studies describing outcomes after surgical treatment of chronic ATR using gastrocnemius aponeurosis flaps or semitendinosus tendon grafts with more than 10 patients included. The studies were assessed for quality and risk of bias using the Methodological Items used to assess risk of bias in Non-Randomized Studies (MINORS).

Results

Out of the 818 studies identified with the initial search, a total of 36 studies with 763 individual patients were included in this systematic review. Gastrocnemius aponeurosis flap was used in 21 and semitendinosus tendon graft was used in 13 of the studies. The mean (SD) postoperative Achilles tendon Total Rupture Score (ATRS) for patients treated with a gastrocnemius aponeurosis flap was 83 (14) points and the mean (SD) American Orthopaedic Foot and Ankle Score (AOFAS) was 96 (1.7) points compared with ATRS 88 (6.9) points and AOFAS 92 (5.6) points for patients treated with a semitendinosus tendon graft. The included studies generally had low-quality according to MINORS, with a median of 8 (range 2–13) for all studies.

Conclusion

Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts give acceptable results with minimal complications and are valid methods for treating chronic ATR. The main difference is more wound healing complications in patients treated with a gastrocnemius aponeurosis flap and more sural nerve injuries in patients treated with a semitendinosus grafts. The current literature on the subject is of mainly low quality and the absence of a patient-related outcome measure validated for chronic ATR makes comparisons between studies difficult.

Level of evidence

Level IV.
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Metadata
Title
Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts are effective in the treatment of chronic Achilles tendon ruptures – a systematic review
Authors
Niklas Nilsson
Immanuel Stensöta
Katarina Nilsson Helander
Annelie Brorsson
Michael R. Carmont
Sebastian Concaro
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2023
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-023-07064-8

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