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Review Question - QID 3124

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QID 3124 (Type "3124" in App Search)
A 58-year-old golfer fell stepping into a sand trap and ruptured his Achilles tendon one year ago. He initially chose non-operative treatment, but became unsatisfied with a tender fullness behind his ankle and ankle weakness noticeable during his tee shots. At the time of surgery, a large disorganized fibrous mass is found at the site of rupture. Following extensive debridement there is a 5 cm gap between viable tissue ends. Which of the following surgical techniques provides the greatest likelihood of a successful clinical outcome?

Gastocnemius turndown repair augmented with transfer of the posterior tibial tendon

5%

181/3592

Gastocnemius turndown repair augmented with transfer of the extensor digitorum longus

3%

96/3592

Gastocnemius turndown repair augmented with transfer of the flexor hallucis longus

85%

3056/3592

Reconstruction with hamstring autograft

6%

207/3592

Primary repair with the foot in maximal plantarflexion followed by a gradual stretching program

1%

33/3592

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Tendon loss is a complication associated with secondary ruptures of a repaired Achilles tendon and chronic Achilles tendon ruptures. Gastrocnemius turndown utilizes a slip of the central third of the gastrocnemius tendon to bridge the gap. Flexor hallicus longus (FHL) is the preferred tendon transfer to augment tissue loss due to its proximity and vascularity. Answer choice 5 is not a prudent option given the risk of equinus contracture and recurrent rupture.

Wapner et al conducted a case review of 7 patients who underwent FHL augmentation for chronic Achilles tendon rupture. Results included no surgical complications, a small but functionally insignificant decrease in ankle and great toe range of motion, and clinical satisfaction of all 7 patients.

Chiodo et al summarize the AAOS clinical guidelines for evaluation and treatment of acute Achilles tendon ruptures predicated upon an extensive review of the literature.

Illustrations A-C depict the steps for a gastrocnemius turn-down flap consisting of a V-Y incision with the arms of the "V" measuring 6cm.

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