A 58-year-old man presents six months after an untreated Achilles tendon rupture. He walks with weakness of push-off and cannot single-leg heel rise. There is a soft tissue defect at the tendon site with retracted proximal and distal stumps that cannot be approximated even with the ankle plantarflexed. The most appropriate reconstructive option is:
- A V-Y advancement flap of the gastrocnemius aponeurosis or flexor hallucis longus augmentation ✓
- B Primary end-to-end repair
- C Ankle arthrodesis
- D Tendo-Achilles lengthening
Correct answer: A. V-Y advancement flap of the gastrocnemius aponeurosis or flexor hallucis longus augmentation
Explanation
Chronic ruptures develop a gap from retraction and scar interposition, so primary end-to-end repair is impossible once the defect exceeds roughly 2 cm. Options include V-Y tendinous advancement from the gastrosoleus aponeurosis, turn-down flaps, or augmentation with flexor hallucis longus transfer. Arthrodesis is a salvage for failed reconstruction with fixed deformity, and simple lengthening cannot bridge a true substance defect. Delayed reconstruction reliably improves strength compared with leaving the defect untreated.
Reference: Campbell's Operative Orthopaedics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.