Surgical treatment of chronic achilles tendon rupture: An anatomical consideration of various autograft options

The vascular supply to the lateral compartment of the leg with emphasis on fibular flap harvesting

PURPOSE

The aim of this study is to determine the exact locations of vascular pedicles that supply the fibularis longus and brevis, to identify the morphometric features of those vessels in the lateral compartment of the leg, and to indicate the branching points of the pedicles from the main arteries.

METHODS

The popliteal arteries of 40 lower limbs from 20 adult cadavers (12 males, 8 females) were bilaterally injected with colored latex. After dissection, the branches of the arteries were identified and counted. The distances between the apex of the head of the fibula and the branching points of the anterior tibial, fibular, and posterior tibial arteries supplying the fibularis longus and brevis muscles were measured.

RESULTS

In all cases, a single artery coursing in the lateral compartment of the leg was identified; it was a branch of the anterior tibial artery and it supplied the proximal and middle thirds of the fibular muscles anteriorly. The mean distance between the origin of this artery and the apex of the fibular head was 8.65 cm. Its mean length was 10.9 cm and the mean number of its branches was 5.1. In all specimens, the fibular artery supplied the proximal and distal portions of the fibular muscles posteriorly.

CONCLUSIONS

This study provides a detailed description of the morphometric properties and branching patterns of the axial pedicle of the anterior tibial artery, which runs longitudinally in the lateral compartment and supplies the fibularis longus and fibularis brevis muscles. We propose naming the pedicle of anterior tibial artery the lateral fibular artery. If this nomenclature is accepted, the fibular artery could be renamed the "posterior fibular artery".

Surgical management of chronic Achilles tendon rupture: evidence-based guidelines

BACKGROUND

Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes.

METHODS

A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines.

RESULTS

Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol.

CONCLUSION

Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.