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Tendon Reconstruction (Achilles and Patellar)
What are tendons?
Muscles begin and end with segments of strong, inelastic tissue called tendons. Tendons anchor the muscle to its associated bones and aid in transmitting the force of the contracting muscle across joints to produce motion. Gliding of the tendon is enhanced by a protective sheath that also plays a role in its nutrition. The characteristics that make tendons strong also make then slow to heal.
How are tendons injured?
The way a tendon is injured is important because it usually determines how it will be repaired. The tendon may be cut sharply (i.e. knife injury), crushed and avulsed (i.e. car accident) or ruptured during sports or strenuous activity.
How are damaged tendons treated?
Sharp injuries without loss of the tendon are repaired with special suture techniques. After a period of protective splinting, physical therapy is initiated to enhance motion. Similarly, rupture or separation of the Achilles tendon from the heel (calcaneus) is often treated using special anchors and sophisticated suture techniques.
Traumatized tendons with small missing segments can be treated with staged tendon grafting or transfer of adjacent tendons. When large segments of tendon and associated skin and muscle are lost during tumor removal and trauma then complex reconstruction is frequently required.
Defects of the quadriceps tendon produce impaired knee extension. Local muscles with dense tendonous surfaces (gastrocnemius) can be reoriented into the knee region to reconstruct the tendon and cover the wound. The lateral thigh provides a source of strong, well-vascularized tissue (iliotibial tract) that can also be utilized for tendon reconstruction. When the size of the wound exceeds the dimensions of local muscles then tissue can be transplanted from another region of the body utilizing microsurgical techniques (free flap).
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Quadriceps and Patellar Reconstruction |
A similar approach is applied to Achilles tendon reconstruction. Weak tendons may be strengthened using local tendon grafts (plantaris tendon) or tendons may be elongated with a stair step technique.
Tendon transfers may be utilized to reconstruct tendon injures in patients with small associated wounds, low impact function and multiple medical problems. Large complex wounds will often require microsurgical reconstruction with the lateral thigh providing a source of expendable tendon, muscle and skin.
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Infected Achilles Tendon Repair
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Infected Achilles Tendon
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Tendon Transfer to Replace the Infected Achilles
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