ArticleJournal of orthopaedic surgery and research2026
Reconstruction of chronic Achilles tendon ruptures using a doubled peroneus longus tendon free graft and interference screw fixation: a technical note.
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe surgical management of chronic Achilles tendon ruptures (CATR) with significant tissue defects (Myerson Type II/III) presents a clinical challenge. Traditional reconstructive methods relying on free hamstring autografts or flexor hallucis longus transfers are often limited by donor-site morbidity, infection risks, or are unavailable in patients with a history of anterior cruciate ligament (ACL) reconstruction. This technical note describes a refined, tissue-preserving surgical technique utilising a doubled free autologous peroneus longus (PL) tendon graft.
methodsUnder regional anaesthesia and thigh tourniquet control, a targeted 4 cm mini-open lateral incision is performed. The PL tendon is identified, harvested proximally using a tendon stripper, and a concomitant distal side-to-side tenodesis of the PL to the PB is performed to minimise eversion weakness. On the back table, the free PL autograft is doubled to achieve a 10 mm diameter construct. A calcaneal tunnel is drilled using progressive reaming. The free graft is routed through the proximal Achilles stump, passed subcutaneously, and drawn through the calcaneus. Final rigid stabilisation is secured with a 10 × 30 mm Bio-Interference Screw (Arthrex®) with the ankle held in maximum forced equinus to ensure optimal tensioning. Postoperatively, a 4-phase accelerated protocol begins with 3 weeks in a short-leg fibreglass cast under protected weight-bearing. RESULTS/TECHNICAL ADVANTAGES: This technique achieves reliable primary mechanical stability, allowing for early protected loading while minimising soft-tissue stripping in the hypovascular distal Achilles watershed area. The free PL autograft provides an adequate structural match, and complements the translational framework of the Soft Tissue Healing Diamond (ST-Diamond) concept. Furthermore, this approach serves as a potential alternative for middle-aged patients who have a history of prior ACL reconstruction using hamstring autografts, avoiding contralateral donor-site morbidity or the use of allografts.
conclusionThe described mini-open free peroneus longus autograft reconstruction with interference screw fixation represents a cautious, reproducible, and biologically sound salvage option for large chronic Achilles tendon defects, balancing mechanical stability with minimal surgical morbidity.
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