Reconstruction of Chronic Achilles Tendon Rupture by V-Y Gastrocnemius Flap and Peroneus Brevis Transfer

Purpose: Reporting the outcome of the modified peroneus brevis (PB) transfertechnique in treating 26 patients with chronic rupture of Achilles tendon (AT). Methods: The diagnosis was neglected acute AT rupture in ten patients, ten with achronic rupture, re-rupture of the tendon in four cases, and Achilles xanthoma in two cases. The gap after debridement was 6 cm in average (range 4-8). The technique was V-Y gastrocnemius flaps of the ruptured AT in addition to peroneus brevis transfer. AOFAS score and isokinetic evaluation were used for functional assessment of ankle plantar flexion torque deficit in average 36 months follow up period (range 24-54 months). Results: Significant improvement of the AOFAS score at latest follow up. No re-rupture nor major complication, particularly of wound healing, was observed, isokinetic testing at 30 degrees/second and 120 degrees/second revealed a significant average decrease of 28 ± 11% and 36 ± 4%, respectively, in plantar flexion peak torque. Although strength deficit persisted at latest follow up, functional improvement was significant without morbidity due to (PB) harvesting. Conclusion: The surgical technique of V-Y myotendinous advancement of gastrosoleus tendon augmented by modified PB transfer for the treatment of chronic or neglected ruptures of AT with a gap of 6 cm length or more is a successful technique leading to high percentage of repair site healing and achieved excellent functional outcome.