Orthopaedic Surgery Department, Hopital Nord, Saint Etienne 42055, Cedex 2, France.
Foot Ankle Int. 2010 Sep;31(9):802-6. doi: 10.3113/FAI.2010.0802.
While conservative treatment may be successful in most cases, partial rupture at the calcaneal insertion point is a significant concern with insertional Achilles tendinopathy. We report on the outcomes of a surgical technique for Achilles tendon augmentation using a bone-tendon graft harvested from the knee extensor system.
Our retrospective case series includes 25 surgical procedures performed in 24 patients, 19 males and five females, with a mean age of 47 (range, 30 to 59) years, 18 of whom were athletes. The mean followup period was 52 (range, 12 to 156) months. All patients underwent MRI examination prior to surgery which showed partial Achilles tendon rupture. The Achilles tendon was debrided through a posterolateral approach. The bone-quadriceps tendon graft was harvested, then the bone plug of the graft was inserted into a blind tunnel drilled into the calcaneus and fixed with an interference screw. The fibers of the quadriceps tendon were sutured to the residual part of the Achilles tendon with the foot at an angle of 90 degrees.
Patients were able to resume their sporting activity after an average of 6.7 months. At last followup examination, physical activity was scored 5.2 on the 10-point Tegner Scale; the mean AOFAS score was 98.4. MRI examination showed good graft integration 1 year postoperatively.
The bone-quadriceps tendon grafting technique was a good alternative for the insertional Achilles lesions with partial detachment which we felt required augmentation.
虽然大多数情况下保守治疗可能成功，但跟腱止点处部分撕裂是跟腱止点腱病的一个重大关注点。我们报告了一种使用取自膝伸肌系统的骨-肌腱移植物增强跟腱的手术技术的结果。
我们的回顾性病例系列包括 24 名患者的 25 例手术，其中男性 19 名，女性 5 名，平均年龄 47 岁（范围 30 岁至 59 岁），其中 18 名是运动员。平均随访时间为 52 个月（范围 12 至 156 个月）。所有患者均在术前接受 MRI 检查，结果显示部分跟腱撕裂。通过后外侧入路切除跟腱。取出骨-四头肌腱移植物，然后将移植物的骨栓插入跟骨内的盲隧道中，并使用干扰螺钉固定。四头肌腱的纤维与足部成 90 度角缝合到跟腱的残留部分。
患者在平均 6.7 个月后能够恢复运动。在最后一次随访检查时，10 分制的 Tegner 评分中活动度评分为 5.2；AOFAS 平均评分为 98.4。术后 1 年 MRI 检查显示移植物有良好的融合。
对于我们认为需要增强的部分分离的跟腱止点病变，骨-四头肌腱移植技术是一种很好的替代方法。
