Operative indications and cases to be wary of

There are no absolute indication for using Graft jacket to reconstruct the Achilles. Generally it should be considered if there is a gap which cannot be bridged.This is either because of poor soft tissue quality (for example at three weeks post injury) or because the proximal tendon end has migrated (such as in a delayed presentation).

It is of up most importance that technically the reconstructed Achilles is placed at the same resting tension as the uninjured side , to avoid overlengthening and thus weakening the repaired side.The uninjured side acts as a template in terms of tendon tension.

It is also of the utmost importance that the patient is aware that allograft is being used and appropriately consented.