Clinical Evaluation of a Minimally Invasive Technique Using a Free Semitendinosus Tendon Graft for Reconstruction of a Chronic Achilles Tendon Tear With Wide Gap

Introduction: The conventional approach to treat a chronic Achilles tendon tear with a wide gap is associated with many problems, primarily difficulty in filling the gap and skin complications. We used a minimally invasive technique to circumvent the problems. Materials and Methods: The study included 10 patients with chronic Achilles tendon tears with a wide gap (>6 cm, Kuwada type 4), who underwent reconstruction using free semitendinosus tendon graft transfer by a minimally invasive technique. Patients were followed up for 12 months. Toe walking, loss of dorsiflexion, and the American Orthopedic Foot and Ankle Score were assessed. The technique was also evaluated for any complications. Results: The age of the patients ranged from 40 to 53 years. The time since injury varied from 18 to 33 weeks. Full weight-bearing was achieved by 8 weeks in all the patients. All patients were able to walk on toes without assistance at 6 months. The mean American Orthopedic Foot and Ankle Score increased from 40.8 to 80.4 after the operation. Only 1 patient developed a superficial skin infection, which resolved with treatment. Conclusions: Semitendinosus graft transfer is a reliable method to treat chronic Achilles tendon rupture with a wide gap, as this wide gap can be covered easily, has a low risk of donor-site morbidity, and can be used even in tears at the insertion site, with good results. With the minimally invasive technique, the intervening skin bridge is maintained, leading to fewer skin complications.