Skip to main content
Top
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Technical advance

Quadriceps autograft to treat Achilles Chronic tears: a simple surgical technique

Authors: Rafael Arriaza, Raquel Gayoso, Emilio López-Vidriero, Jesús Aizpurúa, Carlos Agrasar

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Login to get access

Abstract

Background

Chronic Achilles tendon tears could hinder patients and represent a challenge to surgeons. Although many different surgical techniques have been proposed for reconstruction of a neglected Achilles tendon rupture, there is no clear evidence to support one technique over the others, but the use of a technique that could allow for an “anatomical” reconstructions seems desirable.

Methods

The present paper describes a new anatomic Achilles tendon reconstruction for chronic tears, using a quadriceps tendon autograft as graft source, with PRP injected into the graft and the neighbor tissue, and fixation in a bone trough with a simple small fragments screw.

Results

Autologous quadriceps tendon graft seems an excellent option, although -surprisingly- has received little attention until now.

Conclusions

Autologous Quadriceps tendon graft (in bone-tendon configuration) is a simple technique that could allow surgeons to reconstruct tissue defects in the Achilles tendon with non-expensive hardware.
Literature
1.
go back to reference Inglis AE, Sculco TP. Surgical repair of ruptures of the tendo Achillis. Clin Orthop Relat Res. 1981;156:160–9.PubMed Inglis AE, Sculco TP. Surgical repair of ruptures of the tendo Achillis. Clin Orthop Relat Res. 1981;156:160–9.PubMed
2.
go back to reference Maffullli N. Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81-A:1019–36. Maffullli N. Rupture of the Achilles tendon. J Bone Joint Surg Am. 1999;81-A:1019–36.
3.
4.
go back to reference Porter D, Mannarino F, Snead D, Gabel S, Ostrowski M. Primary repair without augmentation for early neglected Achilles tendon ruptures in the recreational athlete. Foot Ankle Int. 1997;18(9):557–64.CrossRefPubMed Porter D, Mannarino F, Snead D, Gabel S, Ostrowski M. Primary repair without augmentation for early neglected Achilles tendon ruptures in the recreational athlete. Foot Ankle Int. 1997;18(9):557–64.CrossRefPubMed
5.
go back to reference Abraham E, Pankovich AM. Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap. J Bone Joint Surg Am. 1975;57-A:253–5. Abraham E, Pankovich AM. Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap. J Bone Joint Surg Am. 1975;57-A:253–5.
6.
go back to reference Bosworth DM. Repair of defects in the tendo achillis. J Bone Joint Surg. 1956;38-A:111–4.PubMed Bosworth DM. Repair of defects in the tendo achillis. J Bone Joint Surg. 1956;38-A:111–4.PubMed
7.
go back to reference Christensen I. Rupture of the Achilles tendon; analysis of 57 cases. Acta Chir Scand. 1953;106:50–60.PubMed Christensen I. Rupture of the Achilles tendon; analysis of 57 cases. Acta Chir Scand. 1953;106:50–60.PubMed
8.
go back to reference Mann RA, Holmes GB, Seale KS, Collins DN. Chronic rupture of the Achilles tendon: a new technique of repair. J Bone Joint Surg Am. 1991;73-A:214–9. Mann RA, Holmes GB, Seale KS, Collins DN. Chronic rupture of the Achilles tendon: a new technique of repair. J Bone Joint Surg Am. 1991;73-A:214–9.
9.
go back to reference Pintore E, Barra V, Pintore R, Maffulli N. Peroneus brevis tendon transfer in neglected tears of the Achilles tendon. J Trauma. 2001;50:71–8.CrossRefPubMed Pintore E, Barra V, Pintore R, Maffulli N. Peroneus brevis tendon transfer in neglected tears of the Achilles tendon. J Trauma. 2001;50:71–8.CrossRefPubMed
10.
go back to reference Nilsson-Helander K, Sward L, Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. A new surgical method to treat chronic ruptures and reruptures of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2008;16:614–20.CrossRefPubMed Nilsson-Helander K, Sward L, Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. A new surgical method to treat chronic ruptures and reruptures of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2008;16:614–20.CrossRefPubMed
11.
go back to reference Maffulli N, Leadbetter WB. Free gracilis tendon graft in chronic tears of the Achilles tendon. Clin J Sport Med. 2005;15:56–61.CrossRefPubMed Maffulli N, Leadbetter WB. Free gracilis tendon graft in chronic tears of the Achilles tendon. Clin J Sport Med. 2005;15:56–61.CrossRefPubMed
12.
go back to reference Besse JL, Lerat JL, Moyen B, Vincent P, Brunet-Guedj E. Distal reconstruction of the Achilles tendon with a bone-tendon graft from extensor system of the knee. Rev Chir Orthop Reparatrice Appar Mot. 1995;81(5):453–7.PubMed Besse JL, Lerat JL, Moyen B, Vincent P, Brunet-Guedj E. Distal reconstruction of the Achilles tendon with a bone-tendon graft from extensor system of the knee. Rev Chir Orthop Reparatrice Appar Mot. 1995;81(5):453–7.PubMed
13.
go back to reference Philippot C, Wegrzyn J, Grosclaude S, Besse JC. Repair of insertional Achilles tendinosis with a bone-quadriceps tendon graft. Foot Ankle Int. 2010;31(9):802–6.CrossRefPubMed Philippot C, Wegrzyn J, Grosclaude S, Besse JC. Repair of insertional Achilles tendinosis with a bone-quadriceps tendon graft. Foot Ankle Int. 2010;31(9):802–6.CrossRefPubMed
14.
go back to reference Gove JR, Hardy MA. Autograft, allograft and xenograft options in the treatment of neglected Achilles tendon ruptures: a historical review with illustration of surgical repair. Foot Ankle J. 2008;1(5):1–10. Gove JR, Hardy MA. Autograft, allograft and xenograft options in the treatment of neglected Achilles tendon ruptures: a historical review with illustration of surgical repair. Foot Ankle J. 2008;1(5):1–10.
15.
go back to reference Sánchez M, Anitua E, Azofra J, Andía I, Padilla S, Mujika I. Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med. 2007;35(2):245–51.CrossRefPubMed Sánchez M, Anitua E, Azofra J, Andía I, Padilla S, Mujika I. Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med. 2007;35(2):245–51.CrossRefPubMed
16.
go back to reference Richardson DR, Willers J, Cohen BE, Davis WH, Jones CP, Anderson RB. Evaluation of the hallux morbidity of single-incision flexor hallucis longus tendon transfer. Foot Ankle Int. 2009;30:627–30.CrossRefPubMed Richardson DR, Willers J, Cohen BE, Davis WH, Jones CP, Anderson RB. Evaluation of the hallux morbidity of single-incision flexor hallucis longus tendon transfer. Foot Ankle Int. 2009;30:627–30.CrossRefPubMed
17.
go back to reference Pajala A, Kangas J, Ohtonen P, Leppilahti J. Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am. 2002;84-A:2016–21.PubMed Pajala A, Kangas J, Ohtonen P, Leppilahti J. Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am. 2002;84-A:2016–21.PubMed
18.
go back to reference Bergkvist D, Åström I, Josefsson PO, Dahlberg LE. Acute Achilles tendon rupture: a questionnaire follow-up of 487 patients. J Bone Joint Surg Am. 2012;94-A:1229–33. Bergkvist D, Åström I, Josefsson PO, Dahlberg LE. Acute Achilles tendon rupture: a questionnaire follow-up of 487 patients. J Bone Joint Surg Am. 2012;94-A:1229–33.
19.
go back to reference DeAngelis JP, Fulkerson JP. Quadriceps tendon–a reliable alternative for reconstruction of the anterior cruciate ligament. Clin Sports Med. 2007;26:587–96.CrossRefPubMed DeAngelis JP, Fulkerson JP. Quadriceps tendon–a reliable alternative for reconstruction of the anterior cruciate ligament. Clin Sports Med. 2007;26:587–96.CrossRefPubMed
20.
go back to reference Tashjian RZ, Hur J, Sullivan RF, Campbell JT, DiGiovanni CW. Flexor hallucis longus transfer for repair of chronic Achilles tendinopathy. Foot Ankle Int. 2003;24(9):673–6.PubMed Tashjian RZ, Hur J, Sullivan RF, Campbell JT, DiGiovanni CW. Flexor hallucis longus transfer for repair of chronic Achilles tendinopathy. Foot Ankle Int. 2003;24(9):673–6.PubMed
21.
go back to reference Poynton AR, O’Rourke K. An analysis of skin perfusion over the Achilles tendon in varying degrees of plantarflexion. Foot Ankle Int. 2001;22:572–4.PubMed Poynton AR, O’Rourke K. An analysis of skin perfusion over the Achilles tendon in varying degrees of plantarflexion. Foot Ankle Int. 2001;22:572–4.PubMed
22.
go back to reference Kaux JF, Drion PV, Colige A, Pascon F, Libertiaux V, et al. Effects of platelet-rich plasma (PRP) on the healing of Achilles tendons of rats. Wound Repair Regen. 2012;20:748–56.CrossRefPubMed Kaux JF, Drion PV, Colige A, Pascon F, Libertiaux V, et al. Effects of platelet-rich plasma (PRP) on the healing of Achilles tendons of rats. Wound Repair Regen. 2012;20:748–56.CrossRefPubMed
23.
go back to reference Vogrin M, Rupreht M, Dinevski D, Haspl M, Kuhta M, et al. Effects of a platelet gel on early graft revascularization after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind, clinical trial. Eur Surg Res. 2010;45:77–85.CrossRefPubMed Vogrin M, Rupreht M, Dinevski D, Haspl M, Kuhta M, et al. Effects of a platelet gel on early graft revascularization after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind, clinical trial. Eur Surg Res. 2010;45:77–85.CrossRefPubMed
24.
go back to reference Sarzaeem MM, Lemraski MMB, Safdari F. Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer. Knee Surg Sports Traumatol Arthrosc. 2012;20:1386–91.CrossRefPubMed Sarzaeem MM, Lemraski MMB, Safdari F. Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer. Knee Surg Sports Traumatol Arthrosc. 2012;20:1386–91.CrossRefPubMed
25.
go back to reference Maffulli N, Del Buono A, Spiezia F, Maffulli GD, Longo UG, Denaro V. Less-invasive semitendinosus tendon graft augmentation for the reconstruction of chronic tears of the Achilles tendon. Am J Sports Med. 2013;41:865–71.CrossRefPubMed Maffulli N, Del Buono A, Spiezia F, Maffulli GD, Longo UG, Denaro V. Less-invasive semitendinosus tendon graft augmentation for the reconstruction of chronic tears of the Achilles tendon. Am J Sports Med. 2013;41:865–71.CrossRefPubMed
26.
go back to reference Lee KB, Park YH, Yoon TR, Chung JY. Reconstruction of neglected Achilles tendon rupture using the flexor hallucis tendon. Knee Surg Sports Traumatol Arthrosc. 2009;17:316–20.CrossRefPubMed Lee KB, Park YH, Yoon TR, Chung JY. Reconstruction of neglected Achilles tendon rupture using the flexor hallucis tendon. Knee Surg Sports Traumatol Arthrosc. 2009;17:316–20.CrossRefPubMed
Metadata
Title
Quadriceps autograft to treat Achilles Chronic tears: a simple surgical technique
Authors
Rafael Arriaza
Raquel Gayoso
Emilio López-Vidriero
Jesús Aizpurúa
Carlos Agrasar
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-0967-1

Other articles of this Issue 1/2016

BMC Musculoskeletal Disorders 1/2016 Go to the issue