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Plantaris Weave With Hewson Suture Passer for Augmentation of Achilles Tendon Repair

Multiple techniques using tendon grafts to augment the repair of a ruptured Achilles tendon have been described in the literature. Most described plantaris augmentations have used wraps of the tendon through or around the reapproximation to enhance the tensile strength of the repair, or a “fanning” of the tendon around the repair site to encourage tissue ingrowth and decrease adhesions. We describe a simple, alternative method of plantaris augmentation using only the Hewson suture retriever. This technique allows weaving of the plantaris directly through the repaired Achilles tendon with minimal trauma to the Achilles or plantaris tendons themselves. The augmentation construct is extended well above and below the reapproximation site for strength and provides large surface area coverage at this level using the proximal end of the plantaris. Of the seven patients that have had this procedure performed, all are independently ambulatory. Six of the seven were willing to allow us to obtain final evaluation. Average time to follow-up was 20 ± 17 months (mean ± SD, range 6–47). These patients had an average American Orthopaedic Foot & Ankle Society hindfoot score of 97.3 ± 4.0 (range 90–100). As an objective measurement, we had them do toe raises to measure their heel excursion. Average heel excursion was 76 ± 14.3% (range 52–92%) of the uninjured side. Our method of plantaris augmentation of primary Achilles tendon repair is easy to perform, does not introduce allogeneic material, allows us to mobilize our patients more quickly than with primary repair alone, and results in excellent functional outcome.