A novel modification of Bosworth's technique to repair zone I Achilles tendon ruptures

BACKGROUND: Zone I ruptures of the Achilles tendon and chronic ruptures in zone II with a gap of more than 6 cm are difficult to treat. We describe a technique that is very well suited to this type of rupture. MATERIALS AND METHODS: Seventy-eight patients with chronic rupture of the Achilles tendon were operated on between January 1996 and December 2010. We used a modification of the Bosworth technique in which a strip of the gastrocnemius aponeurosis was taken, made into a tendon-like structure and passed through the calcaneum after making a drill hole; then it was sutured back to the proximal stump. The Leppilahti scoring system was used to evaluate these patients. RESULTS: Sixty-two patients had excellent results, 8 had good results, 4 had fair results, 2 had poor results, and 2 were lost to follow-up at the end of 1 year. Nearly all patients resumed work at 6 months postoperatively, had normal walking and stair climbing, and regained normal dorsiflexion. CONCLUSION: Our technique is ideally suited to zone I ruptures (where no distal stump is available for repair) and ruptures in zone II where end-to-end repair is not possible.