Rare Case of bioinductive collagen implant augmentation for myotendinous achilles rupture in teenage gymnast: A report

In rotator cuff surgery, bioinductive collagen implants have been shown to be safe and effective, demonstrating the ability to induce the growth of tendon-like tissue with increased tendon thickness maintained for several years. These bioinductive implants are not yet well-studied in the augmentation of Achilles tendon repairs. Josiah Valk et al presented a case of a 16-year-old female competitive gymnast with an acute myotendinous Achilles tendon rupture who underwent primary repair with bioinductive collagen patch augmentation. The case report has been published in “JBJS Case Connect.”

“Bioinductive collagen patch augmentation of Achilles tendon repair may be a useful adjunct for myotendinous junction Achilles ruptures, particularly in high-demand patients including competitive gymnasts” - Josiah Valk et al

16-year-old, healthy, female elite gymnast presented to orthopaedic clinic (Beaumont Farmington Hills Hospital, Farmington Hills, Michigan) 8 days after a fall while cheer leading. She complained of pain and weakness in the left ankle. Clinical examination revealed an antalgic gait, moderate soft tissue edema, a palpable Achilles defect, and a positive Thompson test. She was clinically diagnosed with a complete Achilles tendon rupture and offered nonoperative and operative treatments.

“Owing to the patient’s elite athletic status and the unique features of the case, it was discussed with local and national experts in the Subspecialties of Sports and Foot & Ankle. Potential Regeneten patch augmentation was considered because of the treating surgeon’s experience with the implant and consensus expert opinion that it would be useful and safe” - Josiah Valk.

The patient elected for operative management and consented to possible use of the implant. A magnetic resonance imaging (MRI) study was performed for surgical planning, which confirmed a complete Achilles tendon rupture at the myotendinous junction. Surgery was performed 11 days post injury.

A longitudinal incision was made over the posteromedial aspect of the Achilles tendon with dissection through the superficial and deep fascia. End-to-end repair with a locking suture technique was performed in an open fashion using high tensile suture (#2 and #5 FiberWire; Arthrex). The tendon was reduced in the dependent equinus position. The sutures were tied together with excellent approximation. The tendon was then tubularized with absorbable suture, and the frayed ends repaired over top in a pants-over-vest fashion.

The decision was made intraoperatively to augment the repair using bioinductive collagen patch (REGENETEN) due to the myotendinous tear location in this high-demand elite athlete. It was sewn over the repair with absorbable suture (2-0 Vicryl; Ethicon). The wound was closed in layers with a running subcuticular closure and skin glue (Dermabond; Ethicon). She was placed into a well-padded short-leg splint in maximum equinus to unload the repair.

At her 2-week postoperative visit, she was transitioned from her splint into a non–weight bearing short-leg cast. At 6 weeks, she was taken out of her cast.

At 5 months, she maintained full range of motion and was able to do a single-leg heel raise. The MRI study revealed edema at the tendon-patch interface and evidence of tendon healing with increased tendon thickness, from 13.7 x 5.9 mm preoperatively to 17.6 x 14.9 mm postoperatively.

At 12-month follow-up, she retained full active and passive ankle range of motion from 450 of plantar flexion to 200 of dorsiflexion. She had full and symmetric 5/5 strength in ankle plantar flexion, dorsiflexion, inversion, and eversion. The patient had fully returned to sport in competitive gymnastics

Further reading:

Bioinductive Collagen Implant Augmentation for Myotendinous Achilles Rupture in a Teenage Competitive Gymnast A Case Report

Josiah Valk, Michael J. Wilk et al

JBJS Case Connect 2023;13:e22.00383

http://dx.doi.org/10.2106/JBJS.CC.22.00383