Minimum 5-Year Outcomes After Minimally Invasive Achilles Tendon Reconstruction Using Autologous Hamstring Grafts.

BACKGROUND

The Achilles tendon is prone to rupture, particularly in middle-aged men, and chronic injuries are often due to missed diagnoses or inadequate treatment. While acute ruptures can be managed with primary repair, chronic cases with tendon gaps >3 cm require reconstruction. A minimally invasive technique using autologous semitendinosus and gracilis tendon grafts has previously shown favorable short-term outcomes. This study evaluates longer-term outcomes with a minimum 5-year follow-up.

METHODS

This study analyzed 21 patients undergoing minimally invasive Achilles tendon reconstruction with autologous hamstring grafts, compared with 21 healthy controls. magnetic resonance imaging confirmed diagnoses, and surgeries (2016-2019) used the EndoButton system for graft stabilization. Assessments included Achilles tendon Total Rupture Score (ATRS) for patient-reported outcomes, EuroQoL-5 Dimensions, 5 Levels (EQ-5D-5L) for overall health, and visual analog scale (VAS) for pain and satisfaction. Functional tests measured dorsiflexion (lunge test), calf endurance (heel rise test), and muscle strength (single-leg hop test), comparing operated vs unoperated legs.

RESULTS

ATRS and EQ-5D-5L Index improved from 2 to 5 years ( = .0136,  = .0396), although significance was lost after Bonferroni correction. Functional test results remained stable. The operated limb achieved >90% of the nonoperated side across tests. Compared with controls, patients reported lower EQ-5D-5L scores and greater pain ( < .05), but satisfaction remained high (VAS score 9/10). One retear occurred due to infection.

CONCLUSION

Minimally invasive Achilles tendon reconstruction using hamstring autografts results in sustained functional and subjective improvements at a minimum of 5 years postoperatively. Despite modest residual deficits compared with uninjured controls, high satisfaction and strong limb symmetry support the long-term efficacy of this approach. This study demonstrates that the functional and subjective results of patients after Achilles tendon reconstruction with hamstring graft remain stable and satisfactory at a minimum of 5 years postoperatively.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.