Hybrid Achilles tendon repair with gastrocnemius fascia turn-down flap for fracture of ossified Achilles tendon.

INTRODUCTION AND

IMPORTANCE

Fractures of ossified Achilles tendons are rare and often associated with repetitive jumping and sprinting in young athletes. Although the exact cause of Achilles tendon ossification is unclear, prior trauma and surgery are common contributing factors.

CASE PRESENTATION: A 47-year-old male recreational athlete experienced acute pain in his right heel after a football game. Imaging revealed two calcified fragments within the Achilles tendon (proximal: 3.0 × 1.0 × 1.0 cm; distal: 1.5 × 1.0 × 0.5 cm) and a 2.7 cm tendon gap. Surgical debridement and repair were performed due to the extent of the damage. A gastrocnemius fascia turn-down flap was used to address the 7.2 cm tendon defect. The patient adhered to a post-operative rehabilitation program and successfully returned to sports at the four-month follow-up.

CLINICAL DISCUSSION: Fractures associated with Achilles tendon ossification are uncommon. In active athletes, surgery is typically the preferred treatment, while nonoperative management may be appropriate for older patients. The hybrid repair technique minimizes complications seen in traditional open or percutaneous repairs, such as wound issues, soft tissue infections, and sural nerve injuries.

CONCLUSIONS

The hybrid Achilles tendon repair using a gastrocnemius fascia turn-down flap effectively addressed the tendon defect, preserved viable tissue, and enabled a successful return to sports. This approach provides optimal surgical exposure for debridement and avoids complications associated with conventional techniques, making it a preferred treatment option for athletes.