Chronic Achilles tendon tear: Open augmentation with allograft vs endoscopic augmentation with autograft. A comparative study.

BACKGROUND

Chronic Achilles tendon (AT) ruptures pose a significant reconstructive challenge. While various surgical techniques have been described, comparative data between open allograft augmentation and endoscopic autograft transfer remain scarce.

METHODS

This study evaluated 41 patients with chronic AT rupture treated surgically: 21 underwent open repair with tendon allograft (Group A) and 20 received endoscopic transfer of the flexor hallucis longus (FHL) tendon (Group B). Complications were recorded, and clinical outcomes were compared between groups.

RESULTS

At a minimum 24-month follow-up, both groups showed excellent functional and clinical outcomes. Complication rates were low and comparable: two in Group A (wound dehiscence, deep vein thrombosis) and three in Group B (tibial nerve irritation, plantar pain, insufficient tensioning of the tendon transfer).

CONCLUSIONS

Both techniques achieved high patient-reported outcomes and low complication rates. Open repair with allograft provides durable reconstruction in complex cases, while endoscopic FHL transfer offers a less invasive alternative.

LEVEL OF EVIDENCE: Level III, retrospective comparative study.