Why Do Tendon Grafts in Achilles Repair Matter?

Tendon Grafts in Achilles Repair: Why They Matter
Achilles tendon ruptures are one of the more common musculoskeletal injuries that occur in people who engage in various sports and physical activities. Treatment protocols vary depending on the patient, with options of surgical and nonsurgical methods, which depend on functional demands, occupation, medical comorbidities and surgical fitness. It is important, however, to initiate the appropriate treatment at the right time, to hopefully return the patient to the prior state of activity and fitness. In this article, we’ll touch upon chronic tears and why grafts might be required with surgical treatment.

What Is a Chronic Achilles Tear?
A chronic tear is one that has not been treated for more than 6 weeks, with these being more technically challenging to treat than acute tears. The tissue quality is poorer, the ends of the tendon might be retracted and shortened, which leads to poorer results and outcomes when a primary repair technique is performed. Treatment is always patient specific, and there are reports of a regular primary repair succeeding in patients who have presented in a chronic tear setting. To combat these failures, grafts have been included in the treatment protocols for chronic Achilles tears. Due to the chronicity of the injury, gaps tend to develop between the ends of tendon, and when the ends cannot be brought together, some patients may benefit from the use of a graft.

Autografts vs. Allografts
The optimum mode of treatment depends on multiple factors such as the age, comorbidities, functional demands, skin condition and size of the gap. There are a few types of grafts that are routinely used. Autografts are tissues taken from the same patient, whereas allografts are tissues taken from a donor. There are many advantages and disadvantages of allografts versus autografts, and they depend largely on the specific needs of the surgery and the ease of availability of the graft.

Most Commonly Used Graft in Achilles Repair
The most commonly used Achilles tendon graft is the Flexor Hallucis Longus (FHL) autograft, which helps in movement of the big toe. This graft is highly vascularized which helps provide better blood supply to the repair site, which helps in overall healing, which also allows this graft to be used in patients who present even up to one year later.

Synthetic Grafts as Reinforcement
At times, a synthetic graft is used in conjunction with a soft tissue graft. This might be required to help augment the initial graft, which helps to regain the tensile strength of the tendon which helps in early mobilization and lesser chances of re-ruptures. Most importantly, there are minimal foreign body reactions and soft tissue infections.

Positive Outcomes Are Possible with the Right Treatment

The treatment of a chronic Achilles injury can be quite an arduous experience, with a multitude of factors that define the treatment plan. In chronic settings grafts have been shown to be not only necessary but also have very positive results that enable the patient to return to a satisfactory level of pre-injury functionality. It is important to avoid delays in treatment to cause chronic conditions, but even so, there are options to help treat this condition. Please make an appointment with one of our Rothman foot and ankle specialists, and they will guide you on the correct treatment option.