The Use of the Median Raphe of Gastrocnemius to Augment the Repair of Achilles Tendon Rupture

Rupture of the Achilles tendon is a common injury among athletes and even sedentary individuals. Presence of a gap between the two ends of the disrupted tendon makes the treatment difficult, however, augmented repair techniques are used in defective Achilles tendon ruptures and provide excellent functional results in active individuals, but it carries an incidence of wound complications like tendon adhesion to the skin. In this study we present an augmentation technique for Achilles tendon rupture that would prevent tendon adhesion to the skin.Material and methods: This prospective study was conducted in King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia from March 2009 to March 2011 on 12 male patients with defective Achilles tendon ruptures. We used an apponeurotic strip from the median raphe of gastrocnemius, and twisted 180 degrees on itself from medial sides, to allow its smooth external surface to lie next to the skin and cover the rupture site, and the plantaris tendon was incorporated in the repair site.Results: Twelve male patients with a mean age of 37 years (27-55) were diagnosed as having a ruptured Achilles tendon. Ten patients had been injured during sports activities the other two cases occurred during walking. The mean duration of ruptures before surgery was (20 days) ranging from 3 to 40 days. The mean follow up was 22 months (11- 35) There were no re-ruptures. Three patients had skin necrosis and managed by debridement followed by secondary sutures and satisfactory healing was achieved. There were no tendon adhesion to the skin and the skin over the tendon was movable. All patients returned to their activity after 6- 14 months (mean 8 months). Conclusion: augmented operative repair of Achilles tendon ruptures is a reliable treatment method for active patients and the repair is preferred to prevent tendon adhesion to the skin.