Evaluating the effectiveness of Baker's procedure in restoring functionality in neglected Achilles tendon injuries


  • Mohammad Sabbir Hossain Department of Orthopaedics, Chandpur Medical College, Chandpur, Bangladesh
  • Muhammad Shahiduzzaman Department of Orthopaedics, Dhaka Medical College and Hospital, Dhaka, Bangladesh
  • M. Shahadat Hossain Department of Orthopaedics, 250 Bed General Hospital, Chandpur, Bangladesh
  • Mohammad Anisur Rahman Department of Orthopaedics, 250 Bed General Hospital, Chandpur, Bangladesh




Tendon, Achilles, Reconstruction


Background: Neglected Achilles tendon injuries present a significant challenge in orthopedic practice, often requiring complex surgical interventions for effective treatment. This study aims to evaluate the functional outcomes of patients with neglected Achilles tendon injuries treated using Baker's procedure, a surgical technique designed for complex cases.

Methods: This prospective interventional study was conducted at multiple medical centers in Dhaka, Bangladesh, from January 1, 2012, to May 31, 2013. It included 42 patients aged 18 to 60 years with signs of old Tendo-Achilles rupture. Participants were selected based on specific inclusion and exclusion criteria and underwent Baker's Procedure. Postoperative assessments included pain levels, ankle stiffness, calf-muscle weakness, footwear restrictions, range of motion, and patient satisfaction, evaluated using the Juhana Leppilahti modified score.

Result: The majority of patients (85.71%) reported no pain post-treatment, while 14.29% experienced mild pain. Ankle stiffness was absent in 71.43% of the patients and mild in 28.57%. Calf-muscle weakness varied, with 64.29% showing no weakness, 28.57% mild weakness, and 7.14% moderate weakness. Footwear restrictions were minimal, with 92.86% reporting no restrictions. Active range of motion was normal (≤5°) in 64.29% of patients and mildly limited (6-10°) in 35.71%. Patient satisfaction was high, with 71.43% being 'Very satisfied' with their treatment outcomes.

Conclusions: The study demonstrates that Baker's Procedure is an effective surgical intervention for neglected Achilles tendon injuries, leading to significant pain relief, restored functional mobility, and high patient satisfaction. These findings suggest that with appropriate surgical and rehabilitative care, patients with complex Achilles tendon injuries can achieve favorable outcomes, emphasizing the importance of tailored surgical approaches in orthopedic practice.


Wang Y, Zhou H, Nie Z, Cui S. Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis. Sports Med Health Sci. 2022;4(3):152-9.

Egger AC, Berkowitz MJ. Achilles tendon injuries. Curr Rev Musculoskelet Med. 2017;10(1):72-80.

Roberts TJ. The integrated function of muscles and tendons during locomotion. Comparative Biochem Physiol Part A: Molecular Integrative Physiol. 2002;133(4):1087-99.

Wong M, Jardaly AH, Kiel J. Anatomy, Bony Pelvis and Lower Limb: Achilles Tendon. In: StatPearls. Treasure Island (FL): StatPearls. 2023.

Tarantino D, Palermi S, Sirico F, Corrado B. Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play. J Funct Morphol Kinesiol. 2020;5(4):95.

Maffulli N, Via AG, Oliva F. Chronic Achilles Tendon Disorders: Tendinopathy and Chronic Rupture. Clin Sports Med. 2015;34(4):607-24.

Padanilam TG. Chronic Achilles Tendon Ruptures. Foot and Ankle Clinics. 2009;14(4):711-28.

Gil-Melgosa L, Grasa J, Urbiola A, Llombart R, Susaeta Ruiz M, Montiel V et al. Muscular and Tendon Degeneration after Achilles Rupture: New Insights into Future Repair Strategies. Biomedicines. 2021;10(1):19.

Benjamin M, Theobald P, Suzuki D, Toumi H. The anatomy of the Achilles tendon. Achilles Tendon. 2007;3:5-16.

Lorimer AV, Hume PA. Achilles tendon injury risk factors associated with running. Sports Med. 2014;44(10):1459-72.

Mokone GG. Risk factors for Achilles tendon injuries: an emphasis on the identification of specific genetic factors. 2006. Available at: http://hdl.handle. net/11427/3270. Accessed on 10 January, 2024.

Jeanfavre M, Husted S, Leff G. Exercise therapy in the non-operative treatment of full-thickness rotator cuff tears: a systematic review. Int J Sports Physical Therapy. 2018;13(3):335.

Cerovac S, Miranda BH. Tendon ‘turnover lengthening’ technique. J Plastic Reconstruct Aesthetic Surg. 2013;66(11):1587-90.

Chattopadhyay A, McGoldrick R, Umansky E, Chang J. Principles of Tendon Reconstruction Following Complex Trauma of the Upper Limb. Semin Plast Surg. 2015;29(1):30-9.

Baker LD. A rational approach to the surgical needs of the cerebral palsy patient. J Bone Joint Surg Am. 1956;38-A(2):313-23.

Leppilahti J, Forsman K, Puranen J, Orava S. Outcome and prognostic factors of Achilles rupture repair using a new scoring method. Clin Orthop Rel Res. 1998;346:152-61.

Lemme NJ, Li NY, DeFroda SF, Kleiner J, Owens BD. Epidemiology of Achilles Tendon Ruptures in the United States: Athletic and Nonathletic Injuries From 2012 to 2016. Orthop J Sports Med. 2018;6(11):2325967118808238.

Yasui Y, Tonogai I, Rosenbaum AJ, Shimozono Y, Kawano H, Kennedy JG. The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States. BioMed Res Int. 2017;2017:e7021862.

Pardes A, Freedman B, Fryhofer G, Salka N, Bhatt P, Soslowsky L. Males Have Inferior Achilles Tendon Material Properties Compared to Females in a Rodent Model. Ann Biomed Eng. 2016;44(10):2901-10.

Nordenholm A, Nilsson N, Krupic F, Hamrin Senorski E, Nilsson Helander K, Westin O et al. Disappointment and frustration, but long-term satisfaction: patient experiences undergoing treatment for a chronic Achilles tendon rupture-a qualitative study. J Orthop Surg Res. 2022;17(1):217.

Gulati V, Jaggard M, Al-Nammari SS, Uzoigwe C, Gulati P, Ismail N, et al. Management of achilles tendon injury: A current concepts systematic review. World J Orthop. 2015;6(4):380-6.

Park SH, Lee HS, Young KW, Seo SG. Treatment of Acute Achilles Tendon Rupture. Clin Orthop Surg. 2020;12(1):1-8.

Hawks MK. Successful Treatment of Achilles Tendinopathy with Electroacupuncture: Two Cases. Med Acupunct. 2017;29(3):163-5.






Original Research Articles