Less-invasive semitendinosus tendon graft augmentation for the reconstruction of chronic tears of the Achilles tendon

BACKGROUND: Less-extensive and gentler exposure and dissection of deep soft tissues could reduce the times of recovery and rehabilitation after Achilles tendon reconstruction. HYPOTHESIS: A minimally invasive semitendinosus autologous graft reconstruction of the Achilles tendon preserves skin integrity and reduces wound breakdown. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 26 patients underwent minimally invasive semitendinosus autologous graft reconstruction for chronic ruptures to the Achilles tendon. Patients underwent a comparison of preoperative versus postoperative maximum calf circumference and isometric plantarflexion strength and evaluation of postoperative complications. The Achilles Tendon Total Rupture Score (ATRS) was administered at the final follow-up appointment. RESULTS: All patients were reviewed at an average of 8.2 years (range, 7-10 years) from surgery. No patient was lost to follow-up. At final follow-up, the maximum calf circumference was significantly higher than preoperatively but significantly lower than the contralateral side. The isometric plantarflexion strength in the operated leg was lower than in the uninjured one. The mean ATRS was 88. Two patients developed a superficial wound infection, both healing within 2 months from the index surgery after systemic antibiotics and local dressings. One patient developed scar adhesion to the distal wound. All patients returned to their preinjury working occupation; 22 patients returned to their preinjury level of activity at a mean of 6.7 months after surgery. CONCLUSION: This technique is minimally invasive, is safe, and allows most of the patients to return to preinjury daily and sport activities within 9 months from surgery.