Treatment of Chronic Achilles Tendon Ruptures with Tendon Transfers

  • Andrew M. Ebert
  • Kelly Short PT
  • Robert B. Anderson


Treatment delays after complete rupture of the Achilles tendon are not uncommon, because nearly 20% of patients are misdiagnosed on initial examination.1 Numerous definitions of what constitutes a “chronic” or late Achilles tendon rupture have been proposed. A functional definition would be those ruptures left untreated for such a time as to prohibit primary tendon repair. Most would agree that this situation will likely be encountered with complete Achilles ruptures beyond the 4 to 6 week mark.2Distribution of chronic injuries appears to be equal among males and females, with the average age of presentation between 35 and 60 years. The neglected acute rupture includes the usual history of acute pain or sensation of a “pop” occurring in the calf, with subsequent weakness. However, the subset of patients who sustain recurrent partial ruptures often present with more subtle histories. Those with connective tissue disorders or chronic Achilles tendinosis may relate a long...


Achilles Tendon Bone Tunnel Tendon Transfer Flexor Hallucis Longus Flexor Digitorum Longus 
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  1. 1.
    Maffulli N. 1999; Rupture of the Achilles tendon. J Bone Joint Surg 81A:–1019–36.Google Scholar
  2. 2.
    Gabel S, Manoli A. 1994; Foot fellow’s review: neglected rupture of the Achilles tendon. Foot Ankle Int 15:512–7.PubMedGoogle Scholar
  3. 3.
    McGarvey W, Singh D, Trevino S. 1996; Partial Achilles tendon ruptures associated with fluoroquinolone antibiotics: a case report and literature review. Foot Ankle Int 17:496–8.PubMedGoogle Scholar
  4. 4.
    Laseter JT, Russell JA. 1991; Anabolic steroid-induced tendon pathology: a review of the literature. Med Sci Sports Exerc 23:(1)1–3.PubMedGoogle Scholar
  5. 5.
    Deutsch AL, Lund PJ, Mink JH. 1997; MR imaging and diagnostic ultrasound in the evaluation of Achilles tendon disorders, Foot Ankle Clin 2:391.Google Scholar
  6. 6.
    Carden DG, Noble J, Chalmers J,. et al. 1987; Rupture of the calcaneal tendon; the early and late management. J Bone Joint Surg Br 69:416.PubMedGoogle Scholar
  7. 7.
    Cetti R, Christensen SE, Ejsted R,. et al. 1993; Operative versus nonoperative treatment of Achilles tendon rupture: a prospective randomized study and review of the literature. Am J Sports Med 21:791.PubMedCrossRefGoogle Scholar
  8. 8.
    Coughlin MJ. 1999:Disorders of tendons. In: CoughlinMJ, Mann RA, eds. Surgery of the Foot and Ankle, 7th ed. St Louis: Mosby, 844–50.Google Scholar
  9. 9.
    Platt H. 1931; Observations on some tendon ruptures, Br Med J 1:611–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Lynn T. 1966; Repair of the torn Achilles tendon using the plantaris tendon as a reinforcing membrane. J Bone Joint Surg 48A:–268–72.Google Scholar
  11. 11.
    Schedl R, Fasol P. 1979; Achilles tendon repair with plantaris tendon compared with repair using polyglycol threads. J Trauma 19:189–94.PubMedCrossRefGoogle Scholar
  12. 12.
    Turco VJ, Spinella AJ. 1987; Achilles tendon ruptures—peroneus brevis transfer. Foot Ankle 7:(4)253–9.PubMedGoogle Scholar
  13. 13.
    Mann R, Holmes G, Seale K, Collins D. 1991; Chronic rupture of the Achilles tendon: a new technique of repair, J Bone Joint Surg 73A:–214–9.Google Scholar
  14. 14.
    Wapner LK, Pavlock GS, Hecht PJ,. et al. 1993; Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle 14:443–9.PubMedGoogle Scholar
  15. 15.
    Wapner KL, Hecht PJ, Mills RH Jr. 1995; Reconstruction of neglected Achilles tendon injury. Orthop Clin North Am 26:(2)249–63.PubMedGoogle Scholar
  16. 16.
    Silver R, de la Garza J, Rang M. 1985; The myth of muscle balance: a study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg 67B:–432–7.Google Scholar
  17. 17.
    Coull R, Flavin R, Stevens MM. 2003; Flexor hallucis longus tendon transfer: evaluation of postoperative morbidity. Foot Ankle Int 24:(12)931–4.PubMedGoogle Scholar
  18. 18.
    Hansen S. 1991: Trauma to the heel cord. In: Jahss M, ed. Disorders of the Foot and Ankle: Medical and Surgical Management, 2nd ed. : WB Saunders, Philadelphia2355–60.Google Scholar
  19. 19.
    Den Hartog BD. 2003; Flexor hallucis longus transfer for chronic Achilles tendonosis. Foot Ankle Int 24:(3)233–7.PubMedGoogle Scholar
  20. 20.
    Wilcox DK, Bohay DRAnderson JG. 2000; Treatment of chronic Achilles tendon disorders with FHL tendon transfer/augmentation. Foot Ankle Int 21:(12)1004–10.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Andrew M. Ebert
  • Kelly Short PT
  • Robert B. Anderson

There are no affiliations available

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