• 1

    Myerson MS: Achilles tendon ruptures. Instr Course Lect 48: 219, 1999.

  • 2

    Padanilam TG: Chronic Achilles tendon ruptures. Foot Ankle Clin North Am 14: 711, 2009.

  • 3

    Boyden EM, Kitaoka HB, Cahalan TD, et al: Late versus early repair of Achilles tendon rupture: clinical and biomechanical evaluation. Clin Orthop Relat Res 317: 150, 1995.

    • Search Google Scholar
    • Export Citation
  • 4

    Bevilacqua NJ: Treatment of the neglected Achilles tendon rupture. Clin Podiatr Med Surg 29: 291, 2012.

  • 5

    Elftman H: Biomechanics of muscle with particular application to studies of gait. J Bone Joint Surg Am 48: 363, 1966.

  • 6

    Maffulli N, Ajis A, Longo UG, et al: Chronic rupture of tendo Achillis. Foot Ankle Clin North Am 12: 583, 2007.

  • 7

    Den Hartog BD: Surgical strategies: delayed diagnosis or neglected Achilles' tendon ruptures. Foot Ankle Int 29: 456, 2008.

  • 8

    Kuwada GT: Classification of tendo Achillis rupture with consideration of surgical repair techniques. J Foot Surg 29: 361, 1990.

  • 9

    Krahe MA, Berlet GC: Achilles tendon ruptures, re rupture with revision surgery, tendinosis, and insertional disease. Foot Ankle Clin 14: 247, 2009.

  • 10

    Reddy SS, Pedowitz DI, Parekh SG, et al: Surgical treatment for chronic disease and disorders of the Achilles tendon. J Am Acad Orthop Surg 17: 3, 2009.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Karjalainen PT, Soila K, Aronen HJ, et al: MR imaging of overuse injuries of the Achilles tendon. AJR Am J Roentgenol 175: 251, 2000.

  • 12

    Puddu G, Ippolito E, Postachini F: A classification of Achilles tendon disease. Am J Sports Med 4: 145, 1976.

  • 13

    Gibbon WW, Cooper JR, Radcliffe GS: Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis. Br J Sports Med 33: 129, 1999.

  • 14

    Weinfeld SB: Achilles tendon disorders. Med Clin North Am 98: 331, 2014.

  • 15

    Christensen I: Rupture of the Achilles tendon: analysis of 57 cases. Acta Chir Scand 106: 50, 1953.

  • 16

    Maffulli N, Ajis A: Management of chronic ruptures of the Achilles tendon. J Bone Joint Surg Am 90: 1348, 2008.

  • 17

    Nicholson CW, Berlet GC, Lee TH: Prediction of the success of nonoperative treatment of insertional Achilles tendinosis based on MRI. Foot Ankle Int 28: 472, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Järvinen TA, Kannus P, Maffulli N, et al: Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin 10: 255, 2005.

  • 19

    Boivin GP, Elenes EY, Schultze AK, et al: Biomechanical properties and histology of db/db diabetic mouse Achilles tendon. Muscles Ligaments Tendons J 4: 280, 2014.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Abate M, Schiavone C, Salini V, et al: Occurrence of tendon pathologies in metabolic disorders. Rheumatology (Oxford) 52: 599, 2013.

  • 21

    Basic-Jukic N, Juric I, Racki S, et al: Spontaneous tendon ruptures in patients with end-stage renal disease. Kidney Blood Press Res 32: 32, 2009.

  • 22

    Porter DA, Mannarino FP, Snead D, et al: Primary repair without augmentation for early neglected Achilles tendon ruptures in the recreational athlete. Foot Ankle Int 18: 557, 1997.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Yasuda T, Kinoshita M, Okuda R: Reconstruction of chronic Achilles tendon rupture with the use of interposed tissue between the stumps. Am J Sports Med 35: 582, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Smigielski R: Management of partial tears of the gastro-soleus complex. Clin Sports Med 27: 219, 2008.

  • 25

    Denstad TF, Roaas A: Surgical treatment of partial Achilles tendon rupture. Am J Sports Med 7: 15, 1979.

  • 26

    Kader D, Saxena A, Movin T, et al: Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med 36: 239, 2002.

  • 27

    Saxena A, Cheung S: Surgery for chronic Achilles tendinopathy: review of 91 procedures over 10 years. JAPMA 93: 283, 2003.

  • 28

    Di Matteo B, Filardo G, Kon E, et al: Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy: a systematic review. Musculoskelet Surg 99: 1, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Filardo G, Kon E, Di Matteo B, et al: Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years. Blood Transfus 12: 533, 2014.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Lin JL: Tendon transfers for Achilles reconstruction. Foot Ankle Clin 14: 729, 2009.

  • 31

    Leslie HD, Edwards WH: Neglected ruptures of the Achilles tendon. Foot Ankle Clin 10: 357, 2005.

  • 32

    Gebauer M, Beil FT, Beckmann J, et al: Mechanical evaluation of different techniques for Achilles tendon repair. Arch Orthop Trauma Surg 127: 795, 2007.

  • 33

    Lynn TA: Repair of the torn Achilles tendon, using the plantaris tendon as a reinforcing membrane. J Bone Joint Surg Am 48: 268, 1966.

  • 34

    Schedl R, Fasol P: Achilles tendon repair with the plantaris tendon compared with repair using polyglycol threads. J Trauma 19: 189, 1979.

  • 35

    Pintore E, Barra V, Pintore R, et al: Peroneus brevis tendon transfer in neglected tears of the Achilles tendon. J Trauma 50: 71, 2001.

  • 36

    Maffulli N, Oliva F, Costa V, et al: The management of chronic rupture of the Achilles tendon: minimally invasive peroneus brevis tendon transfer. Bone Joint J 97-B: 353, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Wegrzyn J, Luciani JF, Philippot R, et al: Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. Int Orthop 34: 1187, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Elias I, Besser M, Nazarian L, et al: Reconstruction for missed or neglected Achilles tendon rupture with V-Y lengthening and flexor hallucis longus transfer through one incision. Foot Ankle Int 29: 1238, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Maffulli N, Leadbetter WB: Free gracilis tendon graft in neglected tears of the Achilles tendon. Clin J Sport Med 15: 56, 2005.

  • 40

    Us AK, Bilgin SS, Aydin T, et al: Repair of neglected Achilles tendon ruptures: procedures and functional results. Arch Orthop Trauma Surg 116: 408, 1997.

  • 41

    Cienfuegos A, Holgado MI, Díaz del Río JM, et al: Chronic Achilles rupture reconstructed with Achilles tendon allograft: a case report. J Foot Ankle Surg 52: 95, 2013.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Deese JM, Gratto-Cox G, Clements FD, et al: Achilles allograft reconstruction for chronic achilles tendinopathy. J Surg Orthop Adv 24: 75, 2015.

  • 43

    Haraguchi N, Bluman EM, Myerson MS: Reconstruction of chronic Achilles tendon disorders with Achilles tendon allografts. Tech Foot Ankle Surg 4: 154, 2005.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44

    Oshri Y, Palmanovich E, Brin YS, et al: Chronic insertional Achilles tendinopathy: surgical outcomes. Muscles Ligaments Tendons J 2: 91, 2012.

  • 45

    Chiara Vulpiani M, Guzzini M, Ferretti A: Operative treatment of chronic Achilles tendinopathy. Int Orthop 27: 307, 2003.

  • 46

    Freedman BR, Gordon JA, Soslowsky LJ: The Achilles tendon: fundamental properties and mechanisms governing healing. Muscles Ligaments Tendons J 4: 245, 2014.

Treatment Algorithm for Chronic Achilles Tendon Lesions

Review of the Literature and Proposal of a New Classification

Roberto Buda I Clinic, Rizzoli Orthopedic Institute, Bologna, Italy.

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Francesco Castagnini I Clinic, Rizzoli Orthopedic Institute, Bologna, Italy.

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Gherardo Pagliazzi I Clinic, Rizzoli Orthopedic Institute, Bologna, Italy.

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Sandro Giannini I Clinic, Rizzoli Orthopedic Institute, Bologna, Italy.

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Chronic Achilles tendon lesions (CATLs) ensue from a neglected acute rupture or a degenerated tendon. Surgical treatment is usually required. The current English literature (PubMed) about CATLs was revised, and particular emphasis was given to articles depicting CATL classification. The available treatment algorithms are based on defect size. We propose the inclusion of other parameters, such as tendon degeneration, etiology, and time from injury to surgery. Partial lesions affecting less than (I stage) or more than (II stage) half of the tendon should be treated conservatively for healthy tendons, within 12 weeks of injury. In II stage complex cases, an end-to-end anastomosis is required. Complete lesions inferior to 2 cm should be addressed by an end-to-end anastomosis, with a tendon transfer in the case of tendon degeneration. Lesions measuring 2 to 5 cm require a turndown flap and a V-Y tendinous flap in the case of a good-quality tendon; degenerated tendons may require a tendon transfer. Lesions larger than 5 cm should be treated using two tendon transfers and V-Y tendinous flaps. A proper algorithm should be introduced to calibrate the surgical procedures. In addition to tendon defect size, tendon degeneration, etiology of the lesion, and time from injury to surgery are crucial factors that should be considered in the surgical planning.

Corresponding author: Francesco Castagnini, MD, Rizzoli Orthopedic Institute, Via Pupilli 1, Bologna, 40136, Italy. (E-mail: francescocastagnini@hotmail.it)