Neglected Achilles Tendon Rupture Fixed

9 month neglected Achilles Tendon rupture in a healthy 51 yo female. She ruptured it in an alumni volleyball game.

Plantaris was intact as seen on the axial STIR….. The ends of the tendon were not connected at all by a fibrous plug like they often are. I attribute this to her never quitting yoga, post-injury, despite her profound weakness.
Which was also her main complaint, rather than pain.

We did weave plantaris through the repair as @dkblacklidge recommends. Fortunately, all that was needed to bring the ends together was ~10 degrees plantarflexion and 3cm Allograft we folded on itself to replicate native thickness. Her tissues closed with little tension. We do try and avoid sacrificing FHL unless there are concerns of durability, or the gap size is excessive. Her gap on MR pre-op measured between 5-7cm.