Asmaa Mohamed1, Francesco Oliva2, Stefano Nardoni3, Nicola Maffulli4. 1. Department of Physical and Rehabilitation Medicine, School of Medicine, University of Rome "Tor Vergata", Italy Physical medicine, Rheumatology and rehabilitation Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2. Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy. 3. Department of Pathology "San Filippo Neri Hospital" Rome, Italy. 4. Head of Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK.
Abstract
BACKGROUND: The present case report aimed to determine the results of Flexor Hallucis Longus (FHL) transfer as a second surgery after synthetic tissue reinforcement graft (Artelon®) implanted to a primary repaired Achilles tendon (AT), that was undertaken by another orthopedic. One year post-operative the patient was referred to us with retrocalcaneal pain and difficulty in walking, associated with stiffness and significant impairment of daily living activities. METHODS: MRI and full clinical examination were the outcome measures applied before and 1 year after surgery. Removal of the synthetic graft and subsequent FHL autologous transfer was undertaken and the graft was sent for histology examination. After removing the below knee leg cast, patient started rehabilitation program supervised by a trained physiotherapist. RESULTS: The patient was allowed to return to his normal activities at the sixth post-operative month, 1 year post-surgery MRI showed correct position of the autograft in the calcaneous bone and in the centre of the native AT plus reduced oedema of the AT body, with clinical improvement of the patient who reported no pain and was able to walk on tiptoes. CONCLUSION: Synthetic patch augmentation to enhance tendon healing should be subjected to proper investigation before using it in routine parctice, as it may act as a barrier against proper tendon healing. LEVEL OF EVIDENCE: V.
BACKGROUND: The present case report aimed to determine the results of Flexor Hallucis Longus (FHL) transfer as a second surgery after synthetic tissue reinforcement graft (Artelon®) implanted to a primary repaired Achilles tendon (AT), that was undertaken by another orthopedic. One year post-operative the patient was referred to us with retrocalcaneal pain and difficulty in walking, associated with stiffness and significant impairment of daily living activities. METHODS: MRI and full clinical examination were the outcome measures applied before and 1 year after surgery. Removal of the synthetic graft and subsequent FHL autologous transfer was undertaken and the graft was sent for histology examination. After removing the below knee leg cast, patient started rehabilitation program supervised by a trained physiotherapist. RESULTS: The patient was allowed to return to his normal activities at the sixth post-operative month, 1 year post-surgery MRI showed correct position of the autograft in the calcaneous bone and in the centre of the native AT plus reduced oedema of the AT body, with clinical improvement of the patient who reported no pain and was able to walk on tiptoes. CONCLUSION: Synthetic patch augmentation to enhance tendon healing should be subjected to proper investigation before using it in routine parctice, as it may act as a barrier against proper tendon healing. LEVEL OF EVIDENCE: V.
Authors: Paul Dayton; Jason G DeVries; Adam Landsman; Andrew Meyr; Monica Schweinberger Journal: J Foot Ankle Surg Date: 2015-01-24 Impact factor: 1.286
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