V-Y plasty combined with gastrocnemius aponeurosis turndown repairing the Myerson type <b>Ⅲ</b> chronic Achilles tendon rupture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Feiyu , LIU Yanshi , LIU Kai ,  Aihemaitijiang·Yusufu ,  Jiasharete·Jielile

Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China;

Corresponding?author：

Aihemaitijiang·Yusufu, Email: ahmatjang@163.com; Jiasharete·Jielile, Email: jiashareteJll@163.com

Keywords：

Achilles tendon rupture; Achilles tendon repair; V-Y plasty; tendon transplantation; gastrocnemius aponeurosis

DOI：

10.7507/1002-1892.202111023

Video：

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Objective To investigate the clinical application and effectiveness of V-Y plasty combined with gastrocnemius aponeurosis turndown in the repair of Myerson type Ⅲ chronic Achilles tendon rupture combined with large tendon defect. Methods Between February 2008 and July 2019, 25 patients underwent the V-Y plasty combined with gastrocnemius aponeurosis turndown to treat the Myerson type Ⅲ chronic Achilles tendon rupture. There were 21 males and 4 females. The age ranged from 17 to 56 years, with an average of 34.3 years. Achilles tendon rupture was caused by sports injury in all patients, and the duration from Achilles tendon rupture to operation was 31-70 days, with an average of 53.9 days. After resection of fibrous scar tissue, the distance of Achilles tendon defect was 7-12 cm, with an average of 9.04 cm. The clinical results were evaluated by the Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) score, dorsiflexion and heel raise height before and after operation. Results The donor and recipient wounds of all 25 cases healed by first intention after operation. All patients were followed up 24 months. During the follow-up, 3 patients developed mild wound infection, which was cured after anti-infection treatment. One patient had Achilles tendon exposure, which was cured after local flap transfer and repair. Ultrasound and MRI reexamination at 3-12 months after operation showed no Achilles tendon elongation, adhesion, or re-rupture. At 24 months after operation, the ATRS score, AOFAS score, dorsiflexion and heel raise height of affected side significantly improved when compared with those before operation (P<0.05). However, the dorsiflexion and heel raise height of affected side were still significantly worse than those of the healthy side (P<0.05). Conclusion V-Y plasty combined with gastrocnemius aponeurosis turndown to repair the chronic Achilles tendon rupture can achieve good effectiveness, and the Achilles tendon function significantly improved after repair. However, the procedure is more invasive and has a long duration of intraoperative wound exposure, causing an increased risk of infection, and the aesthetic is not good.

Citation： CAI Feiyu, LIU Yanshi, LIU Kai, Aihemaitijiang·Yusufu, Jiasharete·Jielile. V-Y plasty combined with gastrocnemius aponeurosis turndown repairing the Myerson type Ⅲ chronic Achilles tendon rupture. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(4): 410-414. doi: 10.7507/1002-1892.202111023 Copy

1.	劉蒙, 石芬, 梁偉強, 等. 逆行腓腸神經營養血管皮瓣修復跟腱斷裂術后跟腱外露. 中華整形外科雜志, 2021, 37(9): 1026-1030.
2.	楊二平, 常祖豪, 齊紅哲, 等. 通道輔助跟腱微創縫合系統在MyersonⅠ型和Ⅱ型陳舊性跟腱斷裂中的應用. 中國修復重建外科雜志, 2021, 35(8): 941-945.
3.	劉文科, 聶茂, 王卓群, 等. 陳舊性跟腱斷裂的治療現狀與展望. 中國矯形外科雜志, 2019, 27(18): 1687-1691.
4.	Maffulli N, Via AG, Oliva F. Chronic Achilles tendon disorders: Tendinopathy and chronic rupture. Clin Sports Med, 2015, 34(4): 607-624.
5.	González-Murillo M, Rodrigo-Alonso A, Figueiredo-González H, et al. Conservative treatment of a chronic rupture of Achilles tendon: case report. Acta Ortop Mex, 2016, 30(6): 323-325.
6.	Kraeutler MJ, Purcell JM, Hunt KJ. Chronic Achilles tendon ruptures. Foot Ankle Int, 2017, 38(8): 921-929.
7.	Guclu B, Basat HC, Yildirim T, et al. Long-term results of chronic Achilles tendon ruptures repaired with V-Y tendon plasty and fascia turndown. Foot Ankle Int, 2016, 37(7): 737-742.
8.	Lin YJ, Duan XJ, Yang L. V-Y tendon plasty for reconstruction of chronic Achilles tendon rupture: A medium-term and long-term follow-up. Orthop Surg, 2019, 11(1): 109-116.
9.	Nilsson-Helander K, Thomeé R, Silbernagel KG, et al. The Achilles tendon total rupture score (ATRS): development and validation. Am J Sports Med, 2007, 35(3): 421-426.
10.	Jielile J, Badalihan A, Qianman B, et al. Clinical outcome of exercise therapy and early post-operative rehabilitation for treatment of neglected Achilles tendon rupture: a randomized study. Knee Surg Sports Traumatol Arthrosc, 2016, 24(7): 2148-2155.
11.	Lin Y, Yang L, Yin L, et al. Surgical strategy for the chronic Achilles tendon rupture. Biomed Res Int, 2016, 2016: 1416971. doi: 10.1155/2016/1416971.
12.	施建東, 金晶, 李玢, 等. 帶線錨釘聯合V-Y腱成形術治療陳舊性跟腱斷裂. 中國骨傷, 2019, 32(8): 727-730.
13.	Lee KB, Park YH, Yoon TR, et al. Reconstruction of neglected Achilles tendon rupture using the flexor hallucis tendon. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 316-320.
14.	郝云甲, 范家強, 陶友倫, 等. 全關節鏡下自體肌腱懸吊固定治療老年非止點性MyersonⅢ型陳舊性跟腱斷裂. 中華骨科雜志, 2021, 41(7): 420-426.
15.	郝云甲, 王愛國, 范家強, 等. 全關節鏡下自體半腱肌及股薄肌肌腱修復Myerson Ⅲ型陳舊性跟腱斷裂的療效分析. 中華外科雜志, 2020, 58(9): 718-722.
16.	宋維君, 程杰, 周凌, 等. 緊密縫合縮短跟腱增生愈合瘢痕組織修復Myerson Ⅲ型陳舊性跟腱斷裂的療效分析. 中華創傷雜志, 2019, 35(12): 1115-1119.
17.	Maffulli N, Spiezia F, Testa V, et al. Free gracilis tendon graft for reconstruction of chronic tears of the Achilles tendon. J Bone Joint Surg (Am), 2012, 94(10): 906-910.
18.	Maffulli N, Spiezia F, Pintore E, et al. Peroneus brevis tendon transfer for reconstruction of chronic tears of the Achilles tendon: a long-term follow-up study. J Bone Joint Surg (Am), 2012, 94(10): 901-905.
19.	Aisaiding A, Wang J, Maimaiti R, et al. A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture. Injury, 2018, 49(3): 712-719.

1. 劉蒙, 石芬, 梁偉強, 等. 逆行腓腸神經營養血管皮瓣修復跟腱斷裂術后跟腱外露. 中華整形外科雜志, 2021, 37(9): 1026-1030.
2. 楊二平, 常祖豪, 齊紅哲, 等. 通道輔助跟腱微創縫合系統在MyersonⅠ型和Ⅱ型陳舊性跟腱斷裂中的應用. 中國修復重建外科雜志, 2021, 35(8): 941-945.
3. 劉文科, 聶茂, 王卓群, 等. 陳舊性跟腱斷裂的治療現狀與展望. 中國矯形外科雜志, 2019, 27(18): 1687-1691.
4. Maffulli N, Via AG, Oliva F. Chronic Achilles tendon disorders: Tendinopathy and chronic rupture. Clin Sports Med, 2015, 34(4): 607-624.
5. González-Murillo M, Rodrigo-Alonso A, Figueiredo-González H, et al. Conservative treatment of a chronic rupture of Achilles tendon: case report. Acta Ortop Mex, 2016, 30(6): 323-325.
6. Kraeutler MJ, Purcell JM, Hunt KJ. Chronic Achilles tendon ruptures. Foot Ankle Int, 2017, 38(8): 921-929.
7. Guclu B, Basat HC, Yildirim T, et al. Long-term results of chronic Achilles tendon ruptures repaired with V-Y tendon plasty and fascia turndown. Foot Ankle Int, 2016, 37(7): 737-742.
8. Lin YJ, Duan XJ, Yang L. V-Y tendon plasty for reconstruction of chronic Achilles tendon rupture: A medium-term and long-term follow-up. Orthop Surg, 2019, 11(1): 109-116.
9. Nilsson-Helander K, Thomeé R, Silbernagel KG, et al. The Achilles tendon total rupture score (ATRS): development and validation. Am J Sports Med, 2007, 35(3): 421-426.
10. Jielile J, Badalihan A, Qianman B, et al. Clinical outcome of exercise therapy and early post-operative rehabilitation for treatment of neglected Achilles tendon rupture: a randomized study. Knee Surg Sports Traumatol Arthrosc, 2016, 24(7): 2148-2155.
11. Lin Y, Yang L, Yin L, et al. Surgical strategy for the chronic Achilles tendon rupture. Biomed Res Int, 2016, 2016: 1416971. doi: 10.1155/2016/1416971.
12. 施建東, 金晶, 李玢, 等. 帶線錨釘聯合V-Y腱成形術治療陳舊性跟腱斷裂. 中國骨傷, 2019, 32(8): 727-730.
13. Lee KB, Park YH, Yoon TR, et al. Reconstruction of neglected Achilles tendon rupture using the flexor hallucis tendon. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 316-320.
14. 郝云甲, 范家強, 陶友倫, 等. 全關節鏡下自體肌腱懸吊固定治療老年非止點性MyersonⅢ型陳舊性跟腱斷裂. 中華骨科雜志, 2021, 41(7): 420-426.
15. 郝云甲, 王愛國, 范家強, 等. 全關節鏡下自體半腱肌及股薄肌肌腱修復Myerson Ⅲ型陳舊性跟腱斷裂的療效分析. 中華外科雜志, 2020, 58(9): 718-722.
16. 宋維君, 程杰, 周凌, 等. 緊密縫合縮短跟腱增生愈合瘢痕組織修復Myerson Ⅲ型陳舊性跟腱斷裂的療效分析. 中華創傷雜志, 2019, 35(12): 1115-1119.
17. Maffulli N, Spiezia F, Testa V, et al. Free gracilis tendon graft for reconstruction of chronic tears of the Achilles tendon. J Bone Joint Surg (Am), 2012, 94(10): 906-910.
18. Maffulli N, Spiezia F, Pintore E, et al. Peroneus brevis tendon transfer for reconstruction of chronic tears of the Achilles tendon: a long-term follow-up study. J Bone Joint Surg (Am), 2012, 94(10): 901-905.
19. Aisaiding A, Wang J, Maimaiti R, et al. A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture. Injury, 2018, 49(3): 712-719.

Chinese Journal of Reparative and Reconstructive Surgery

V-Y plasty combined with gastrocnemius aponeurosis turndown repairing the Myerson type Ⅲ chronic Achilles tendon rupture

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