DISTAL RECONSTRUCTION OF THE TENDO ACHILL ES WITH A BONE-TENDON GRAFTHARVESTED FROM THE PATELLAR TENDON

Purpose of the study The authors describe a new surgical technique of tendo achilles reconstruction using bone tendon plasty from the patell ar tendon, for rare chronic ruptures of the Achilles tendon flush whit h its calcaneal insertion, with distal loss of substance, requiring bo ne fixation. Methods The two step operation was carried out either in lateral or ventral decubitus (the latter two involving repositioning t he patient) 1) Plasty harvesting. By a short anterior approach, we har vested either a strip of patellar tendon (10 mm wide) with a piece of tibia tuberosity or a strip of rectus femoris tendon (10 mm wide, up t o 10-15 cm long) with a piece of patellar bone, in cases with a greate r loss of substance. Tendo achilles reconstruction : following resecti on of fibrous tissue, and drilling of a blind calcaneous tunnel, the b one plasty is fitted into the calcaneous with interference screw for s afety, the two tendon ends are superposed and sutured. The patient is placed in a cast for two months. Results Two patients (1 thirty-eight year old sportsman, 1 thirty-seven year old woman) were treated with a good morphological and functionnal outcome at two years. Discussion T his new technique is compared with other available solutions: triceps plasty other local tendon plasties artificial plasties. It met the two criteria for these unusual ruptures: solid calcaneous fixation no ski n damage.