Management of Missed Traumatic Achilles Tendon Rupture in a Pediatric Patient: A Case Report

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


BACKGROUND: Missed traumatic Achilles tendon ruptures in children are rarely reported in the literature. Various techniques have been described to reconstruct delayed Achilles tendon ruptures for adults, but the long-term consequences in the growing child are unknown.

CLINICAL CASE: The article presents a clinical observation of a 8-year-old girl with missed rupture of the Achilles tendon operated 7 weeks after the trauma by end-to-end Kessler-type sutures augmented with the plantaris tendon. At 2-year follow-up, the patient was completely asymptomatic.

DISCUSSION: A review of the literature shows that this is the third neglected pediatric case of post-traumatic Achilles tendon rupture. The first case concerns a 10-year-old boy treated successfully six weeks after the traumat by open surgical repair using the Bunnell sutures technique. The second patient was a 7-year-old girl, she was operated 8 weeks after the trauma with a termino-terminal tenorrhaphy using the Bunnell technique augmented with the plantaris tendon.

CONCLUSIONS: Using the plantaris tendon to reinforce the Achilles tendon repair offers satisfactory results with minimal morbidity. Prognosis depends on the extent of tendon defect which determines the long-term functional outcome. Any skin wound that sits on the back of the leg requires a systematic and careful physical examination to check the integrity of the Achilles tendon.

Full Text

Restricted Access

About the authors

Saad Andaloussi

Marche Verte Hospital, Regional Delegation of Public Health Boulemane

Author for correspondence.
ORCID iD: 0000-0002-5382-1481

MD, pediatric surgeon

Morocco, Avenue Annakhil, Missour 33250


  1. Gabel S, Manoli A. Neglected rupture of the Achilles tendon. Foot Ankle Int. 1994;15(9):512−517. doi: 10.1177/107110079401500912
  2. Lynn TA. Repair of the torn achilles tendon, using the plantaris tendon as a reinforcing membrane. J Bone Joint Surg Am. 1966;48(2):268−272.
  3. Quigley TB, Scheller AD. Surgical repair of the ruptured Achilles tendon: Analysis of 40 patients treated by the same surgeon. Am J Sports Med. 1980;8(4):244−250. doi: 10.1177/036354658000800406
  4. Akdogan M, Atilla HA, Barca F. Pediatric Achilles tendon laceration: a case report and systematic review of literature. MOJ Sports Med. 2018;2(5):153–156. doi: 10.15406/mojsm.2018.02.00066
  5. Maffulli N. Clinical tests in sports medicine: more on Achilles tendon. Br J Sports Med. 1996;30(3):250−250. doi: 10.1136/bjsm.30.3.250
  6. Maffulli N. Current concepts review – rupture of the Achilles tendon. J Bone Joint Surg. 1999;81(7):1019−1036. doi: 10.2106/00004623-199907000-00017
  7. Thompson TC. A test for rupture of the tendo achillis. Acta Orthop Scand. 1962;32(1-4):461−465. doi: 10.3109/17453676208989608
  8. Vasileff WK, Moutzouros V. Unrecognized pediatric partial Achilles tendon injury followed by traumatic completion: A case report and literature review. J Foot Ankle Surg. 2014;53(4):485−488. doi: 10.1053/j.jfas.2014.02.016
  9. Tudisco C, Bisicchia S. Reconstruction of neglected traumatic Achilles tendon rupture in a young girl. J Orthopaed Traumatol. 2012;13(3):163−166. doi: 10.1007/s10195-012-0178-y
  10. Eidelman M, Nachtigal A, Katzman A, Bialik V. Acute rupture of achilles tendon in a 7-year-old girl. J Pediatric Orthop B. 2004;13(1):32−33. doi: 10.1097/01.bpb.0000078723.48512.7e
  11. Hadi M, Young J, Cooper L, et al. Surgical management of chronic ruptures of the Achilles tendon remains unclear: a systematic review of the management options. Br Med Bull. 2013;108(1):95−114. doi: 10.1093/bmb/ldt019
  12. Porter DA, Mannarino FP, Snead D, et al. Primary repair without augmentation for early neglected achilles tendon ruptures in the recreational athlete. Foot Ankle Int. 1997;18(9):557−564. doi: 10.1177/107110079701800905
  13. Bosworth DM. Repair of defects in the tendo achillis. J Bone Joint Surg Am. 1956;38-A(1):111−114.
  14. Abraham E, Pankovich AM. Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap. J Bone Joint Surg Am. 1975;57(2):253−255.
  15. Bugg EI, Boyd BM. Repair of neglected rupture or laceration of the Achilles tendon. Clin Orthop Relat Res. 1968;56:73−75.
  16. Maffulli N, Spiezia F, Testa V, et al. Free gracilis tendon graft for reconstruction of chronic tears of the Achilles tendon. J Bone Joint Surg. 2012;94(10):906−910. doi: 10.2106/JBJS.K.00869
  17. McClelland D, Maffulli N. Neglected rupture of the Achilles tendon: Reconstruction with peroneus brevis tendon transfer. Surgeon. 2004;2(4):209−213. doi: 10.1016/S1479-666X(04)80002-7
  18. Wapner KL, Pavlock GS, Hecht PJ, et al. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle. 1993;14(8):443−449. doi: 10.1177/107110079301400803
  19. Mann RA, Holmes GB, Seale KS, Collins DN. Chronic rupture of the Achilles tendon: a new technique of repair. J Bone Joint Surg Am. 1991;73(2):214−219.
  20. Razik ISA. Surgical treatment of chronic Achilles tendon rupture. J Foot Ankle Surg. 2009;48(3):340−346. doi: 10.1053/j.jfas.2009.02.007
  21. Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of Achilles tendon Rruptures. Am J Sports Med. 2002;30(4):565−575. doi: 10.1177/03635465020300041701
  22. Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes. Am J Sports Med. 2002;30(2):287−305. doi: 10.1177/03635465020300022501

Supplementary files

Supplementary Files
1. Fig. 1. Clinical examination: a, the patient has increased dorsiflexion of the ankle joint (arrow) compared to the contralateral side; b, healed skin wound of about 4 cm in the mid-portion of the tendon; c, presence of visible and palpable tendon depression indicating the location of the defect

Download (111KB)
2. Fig. 2. Stages of surgical intervention: a, posteromedial skin incision centered on the rupture; b, gap between the two tendon stumps was approximately 3 cm after the tendon edges are mobilized; c, plantaris tendon was harvested leaving the distal end inserted; d, final view of the reconstructed Achilles tendon using plantaris tendon as an augmentation

Download (197KB)
3. Fig. 3. Two years after the surgery: a, plantarflexion strength is the same as the uninjured side; b, the patient is able to do a heel raise; c, no skin complications have been noted

Download (258KB)

Copyright (c) 2021 Andaloussi S.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies