Résumé
Objective To explore clinical effect of reconstruction for chronic Achilles tendon rupture of Kuwada IV type with flexor hallucis longus (FHL) harvested using a minimally invasive technique.Methods The data of 35 patients with chronic Achilles tendon rupture of Kuwada IV type was retrospectively analyzed who were treated by FHL which was harvested using a minimally invasive technique from July 2006 to June 2011.There were 21 males and 14 females,with the age from 23 to 71 years (average,42.1 years).All patients were unilateral injury.MRI showed Achilles tendon rupture fissures 6.0-9.2 cm.The local appearance and function recovery on postoperation was observed,and all patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Leppilahti Achilles tendon repair score.Results Thirty-two patients were followed up for 18 to 72 months,with an average of 33.2 months.Except for 1 patient whose wound healed after six weeks through resuture immediately for the wound dehiscence occurred in the ten days,other patients' wound healed smoothly.The average of AOFAS ankle-hindfoot score had increased from 51.92±7.08 preoperatively to 92.56±6.71 postoperatively.Leppilahti Achilles tendon repair score had increased from 72.56±7.43 preoperatively to 92.58±5.1 postoperatively.Twenty-seven cases were excellent,good in 3,and fair in 2,with the total excellent and good rate 93.8％ (30/32).No case of the sural nerve and tibial nerve injury,plantar painful scar,plantar outside nerve injury.MRI of Achilles tendon showed even signal without signal of tear and cystic degeneration.Conclusion Reconstruction for chronic Achilles tendon rupture of Kuwada IV type with FHL harvested using a minimally invasive technique offers a desirable outcome in rapid postoperative recovery,high strength in tenodesis,fewer complications.