J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 7, July 2017, pages 573-578

Chronic Achilles Tendon Rupture Reconstruction Using the Lindholm Method and the Vulpius Method

Figure 1. Schematic illustration of the Lindholm technique (a, b) and primary repair with Vulpius’ lengthening of the gastrocnemius (c, d).

Figure 2. Intraoperative view of the Lindholm technique application. (a) Reconstruction of Achilles rupture defect with medial and lateral flaps harvested from the gastrocnemius. (b) Final view of the reconstruction after augmentation of the plantaris longus tendon.

Figure 3. Intraoperative view of the Vulpius technique application. (a) The view of the gap at the chronically ruptured Achilles tendon. (b) The final view of the primary repair of the defect after lengthening of the gastrocnemius via a reverse V shape.

**Table 1.** Patient Characteristics
Patients	Sex	Age	Side	Gap (cm)	Cause of injury	Time between injury and surgery (day)	Follow-up (months)	Immobilized (week)	Surgical technique
1	M	28	L	6	Football	40	12	3	Primary repair + Vulpius
2	M	39	R	3	Football	30	18	4	Primary repair + Vulpius
3	M	38	R	4	Football	30	14	5	Primary repair + Vulpius
4	M	28	R	4	Football	45	15	5	Primary repair + Vulpius
5	M	42	L	3	Football	35	21	5	Primary repair + Vulpius
6	F	36	R	4	Fall	50	24	4	Primary repair + Vulpius
7	M	39	L	3	Football	35	20	4	Primary repair + Vulpius
8	M	32	L	4	Football	60	24	3	Lindholm
9	M	39	R	4	Football	45	18	5	Lindholm
10	M	41	R	4	Football	60	17	5	Lindholm
11	M	32	R	5	Fall	60	13	6	Lindholm
12	M	40	R	3	Football	45	12	3	Lindholm
13	M	34	R	5	Football	30	24	4	Lindholm
14	F	22	L	4	Fall	30	24	3	Lindholm
15	M	38	R	4	Football	35	38	3	Lindholm

Table 1. Patient Characteristics

Patients

Sex

Age

Side

Gap (cm)

Cause of injury

Time between injury and surgery (day)

Follow-up (months)

Immobilized (week)

Surgical technique

Football

Primary repair + Vulpius

Football

Primary repair + Vulpius

Football

Primary repair + Vulpius

Football

Primary repair + Vulpius

Football

Primary repair + Vulpius

Fall

Primary repair + Vulpius

Football

Primary repair + Vulpius

Football

Lindholm

Football

Lindholm

Football

Lindholm

Fall

Lindholm

Football

Lindholm

Football

Lindholm

Fall

Lindholm

Football

Lindholm

**Table 2.** The Hooker Assessment Scale
Excellent	Satisfactory	Poor
None of patients had symptoms	Patients were free from symptoms but there was weakness of the calf detected or excessive passive dorsiflexion of the ankle.	In addition to the findings of satisfactory, the patients experienced symptoms either of weakness of the ankle or foot or of a limp or pain.

Table 2. The Hooker Assessment Scale

Excellent

Satisfactory

Poor

None of patients had symptoms

Patients were free from symptoms but there was weakness of the calf detected or excessive passive dorsiflexion of the ankle.

In addition to the findings of satisfactory, the patients experienced symptoms either of weakness of the ankle or foot or of a limp or pain.

**Table 3.** Clinical Outcomes of Patients
Patients	Returned to pre-injury daily activities (months)	Stand on tiptoe	Plantar flexion (°)	Dorsiflexion (°)	Calf atrophy (cm)	Satisfaction (Hooker classification)	Complication
1	2	Normal	40	15	0	Excellent	No
2	2	Normal	45	20	0	Excellent	No
3	2	Normal	32	25	2	Excellent	No
4	5	Normal	35	24	2	Excellent	No
5	5	Normal	28	25	2.5	Excellent	No
6	4	Normal	30	15	1	Satisfactory	No
7	4	Normal	35	20	0	Excellent	No
8	3	Normal	40	20	0	Excellent	No
9	3	Normal	40	20	1	Excellent	No
10	3.5	Normal	40	15	2	Excellent	No
11	3.5	Normal	35	15	2	Satisfactory	No
12	4	Normal	40	15	2	Satisfactory	No
13	3	Normal	40	15	1	Excellent	No
14	2	Normal	45	20	1	Satisfactory	No
15	3	Normal	40	15	2	Excellent	No

Table 3. Clinical Outcomes of Patients

Patients

Returned to pre-injury daily activities (months)

Stand on tiptoe

Plantar flexion (°)

Dorsiflexion (°)

Calf atrophy (cm)

Satisfaction (Hooker classification)

Complication

Normal

Excellent

Normal

Excellent

Normal

Excellent

Normal

Excellent

Normal

2.5

Excellent

Normal

Satisfactory

Normal

Excellent

Normal

Excellent

Normal

Excellent

3.5

Normal

Excellent

3.5

Normal

Satisfactory

Normal

Satisfactory

Normal

Excellent

Normal

Satisfactory

Normal

Excellent