The Efficacy Analysis Of The Autologous Fascia Lata Transplantation In The Treatment Of The Closed Chronic Achilles Tendon Rupture

Objective:To observe and explore the clinical effect of the autologous fascia lata transplantation in the treatment of the closed chronic achilles tendon rupture,to compare it with transposition of the flexor hallux longus tendon and to provide an alternative surgical method for the treatment of the closed chronic achilles tendon rupture.Methods:From January 2014 to December 2019,patients with Achilles tendon rupture were treated in our hospital.Inclusion criteria were as follows:(1)closed Achilles tendon rupture with a disease duration more than 4 weeks;(2)autologous fascia lata transplantation or transposition of the flexor hallux longus tendon.Exclusion criteria were as follows:(1)patients with bilateral Achilles tendon rupture;(2)patients with rupture at the insertion point and the need of insertion point reconstruction;(3)patients with avulsion fractures,multiple injuries,soft tissue defects and other complications;(4)patients with severe systemic diseases;(5)patients with severe degeneration of Achilles tendon caused by Achilles tendinitis and long-term application of glucocorticoids,quinolones,etc.A total of 17 patients with the autologous fascia lata transplantation were included.There were 16 males of 16 foots and 1 female of 1 foot,with the age 40.82±11.58 years old,height 172.29±6.23 cm and weight 77.29±12.41 kg.There were 11 left foots and 6 right foots.The time from injury to operation was 80.24±44.03 days.A total of 11 patients with the flexor hallux longus tendon transposition were included.There were 11 males of 11 foots,with the age 47.45±11.84 years old,height 172.73±3.47 cm and weight 78.18±9.79 kg.There were 6 left foots and 5 right foots.The time from injury to operation was 106.36±33.84 days.The patients were followed up,observed and recorded for their recovery and complications.The AOFAS Ankle-Hindfoot score,Arner-Lindholm grading,ATRS score and VISA-A score were used to evaluate and compare the recovery preoperatively,half a year and one year after surgery(see the appendix for details).Results:The group of autologous fascia lata transplantation:The operative duration was 114.12±23.93 minutes,the intraoperative bleeding was 21.18±17.28ml and the defect length between the broken ends was 5.12±1.11 cm after the removal of the degenerated and devitalized tissue at the broken end.All the patients were followed up within one year,and the follow-up duration was 15.35±2.98 months.The group of the flexor hallux longus tendon transposition:The operative duration was 124.55± 19.16 minutes,the intraoperative bleeding was 24.55±14.40 ml and the defect length between the broken ends was 5.73±1.27 cm after the removal of the degenerated and devitalized tissue at the broken end.All the patients were followed up within one year,and the follow-up duration was 17.45±3.24 months.At the last follow-up,all the patients were able to stand on single foot and lift their heels,and all the patients were satisfied with the surgical effect.No complications were found in all patients such as re-rupture,delayed incision healing,incision non-healing,infection,deep vein thrombosis,hypoesthesia,achillodynia,achilles tendon contracture,ahilles tendon flab,muscle hernia,etc.The group of autologous fascia lata transplantation:One year after the surgery,AOFAS score was 95.94±4.45,ATRS score was 92.71±4.30,and VISA score was 90.00±9.75.The excellent and good rates of AOFAS and Arner-Lindholm grading were both 100%.The group of the flexor hallux longus tendon transposition:One year after the surgery,AOFAS score was 80.09±4.59,ATRS score was 81.27±4.61,and VISA score was 78.45±8.70.The excellent and good rate of AOFAS was 90.91%and that of Amer-Lindholm grading was 100%.AOFAS Ankle-Hindfoot score,Amer-Lindholm grading,ATRS score and VISA-A score were significantly improved over time in the group of fascia lata transplantation(p<0.05).In the improvement of AOFAS score,ATRS score and VISA-A score,the effect of fascia lata transplantation was better than that of the flexor longus tendon transposition.In the improvement of Arner-Lindholm grading,fascia lata transplantation had the same effect as the flexor longus tendon transposition.Conclusion:In the treatment of the closed chronic achilles tendon rupture,autologous fascia lata transplantation has the good prognosis and may be a possible clinical treatment.