Chronic Achilles Tendon Analysis
Management of chronic Achilles tendon ruptures is indeed difficult and challenging. The proximal and distal stumps are often retraced and atrophic.
To the extent of our knowledge, there are no evidence-based guidelines for selecting the optimum surgical interference for management for chronic ruptures of the Achilles tendon. However, Myerson15 classified chronic Achilles tendon into three types; Type-1 defect is less than no 1 to 2 cm long and this can be repaired end-to-end repair with or without posterior compartment fasciotomy. Type-2 defect is greater than 2 cm however less than 5 cm. This can be managed by V-Y lengthening, with or without a tendon transfer. A Type-3 defect is greater than 5 cm and this should by bridged by the use of a
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Although there is also loss of the active interdigital planter flexion of the big toe and this usually had no effect to the patient26 .
Peroneus brevis tendon transfer has gained popularity However, there is a concern about the reduced strength of plantar flexion and ankle eversion 27. Recent studies reported that The peroneal muscles provide only 4% of the total work capacity in plantar flexion, and the peroneus brevis provides 28% of the eversion capacity of the hindfoot28. And in this study and similar studies no patient complained of any disability related to these issues.
This study used a combination of V-Y advancement and Peroneus brevis augmentation for management of chronic Achilles rupture with a gap defect more than 6 cm, over a follow up period of 24 months we reported no re-rupture and improvement of the overall Achilles tendon total rupture score from 26.27 to 84.9 and improvement of AOFAS score from 53.18 to
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