The Modified Maffulli s Technique for the Treatment of Achilles Tendon Pathologies

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1 The Modified Maffulli s Technique for the Treatment of Achilles Tendon Pathologies Fernando Raduan, Inacio Asaumi, Caio Nery, Anthony Perera, Alfonso Apostólico Neto, Nicola Maffulli, Daniel Baumfeld

2 Disclosure My disclosure is in the Final AOFAS Mobile App I have no potential conflicts with this presentation

3 Introduction Objective Strongest but the most injured Show clinical and functional Affects high performance and recreational athletes results of patients submitted to a modified percutaneous technique Pain is moderate and up to 30% of the lesions are not diagnosed acutely with ST (Maffulli s) for chronic Achilles tendon lesions and pathologies Chronic lesions are treated with augmentation (Plantaris or Fascia Lata) or tendon transfers (FHL or PB) Allografts are also described Distance between stumps is not the only issue Be aware of skin problems!! Movi T et al; Acute Rupture of Achilles Tendon. Foot Ankle Clin N Am 10 (2005)

4 Material and Methods Ten Patients (11 tendons) from Jan 11 to Jan 13 Chronic ruptures (more than 3 weeks), reruptures and massive tendinopathies AOFAS and VAS pre and post op 20 consecutive single-leg heel raises

5 Physical Exam Loss of posterior ankle silhouette. Can be a problem!!

6 Surgical Technique Guide Isolating Wire the Graft Apporach Complete passage Proximal Transverse Graft passage Interfernce Striping thescrew graftstump fixation Distal Transverse Approach Suture Graft passage proximal

7 Three Months Post Op

8 Results Ten patients 11 tendons months of follow up on average (10~28m) All patients were able to perform 20 single-leg heel raises at the same cadence 55 6,1 2,1 Only one skin breakdown after a fall but the graft was ok AOFAS VAS

9 Discussion Achilles tendon ruptures are common and up to 30% may be missed. Acute lesions can be treated conservatively but neglected lesions show better results after surgery FHL and PB are weaker (40% unable to perform 20 single-leg heel raises) V-Y lengths the system loosing power Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical vs nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Dec 5;94(23):

10 Discussion Distance between stumps is important but the loss of posterior leg silhouette has to be considered Minimally invasive procedures are becoming more popular among surgeons to avoid skin breakdown Technique presented avoids skin problems and uses the original triceps muscle Showed good results Elias I, Besse M, Nazarian LN, Raikin SM. Reconstruction for missed or Neglected Achilles Tendon Ruptures with V-Y Lengthening and FHL Transfer Through One Incision. Foot and Ankle Intl :1238

11 Conclusion Safe technique Good results and low morbidity All patients were able to perform 20 single-leg heel raises Better quality papers should be made

12 References Hamish DH et al. Neglected Ruptures of Achilles Tendon. Foot Ankle Clin N Am 10 (2005) Movi T et al; Acute Rupture of Achilles Tendon. Foot Ankle Clin N Am 10 (2005) Maffulli N et al. Minimally invasive recosntruction of chronic achilles tendon ruptures using the ipsilateral free semitendinosus graft and interference screw. Am J Sports Med May; 41(5) Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical vs nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Dec 5; 94 (23): Elias I, Besse M, Nazarian LN, Raikin SM. Reconstruction for missed or Neglected Achilles Tendon Ruptures with V-Y Lengthening and FHL Transfer Through One Incision. Foot and Ankle Intl :1238 Elias I, Raikin SM, Besser MP nas Nazarian LN. Outcomes of Chronic Insertional Achilles Tendinosis Usin FHL Autograft Through Single Icision. Foot and Ankle Intl : 197. Olsson N et al. Stabel Surgical Repair With Accelerated RehabilitationVerusu Nonsurgical Treatment fof Acute Achilles Tendon Ruptures. A Randomizes Controlled Study. Am J Sports Med Dec

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