Reconstruction of the Achilles tendon using LARS artificial ligament in bilateral xanthoma: a case report and literature review

BACKGROUND: Achilles tendon xanthoma (ATX) is a rare benign lesion characterized by lipid deposition within the tendon and is often associated with hyperlipidemia and genetic diseases. Surgery is challenging due to the risk of recurrence and its impact on patients' quality of life. Reconstruction using a synthetic ligament has not been previously reported for this condition. CASE PRESENTATION: A 35-year-old female patient presented with a progressive mass in both heels over 4 years, accompanied by limited ankle dorsiflexion (5°-10°), a Visual Analogue Scale (VAS) score of 6, and an American Orthopaedic Foot and Ankle Society (AOFAS) score of 51. Laboratory evaluation after 6 months of atorvastatin therapy (20 mg/day) revealed persistent hypertriglyceridemia (3.45 mmol/L) and borderline hypercholesterolemia (total cholesterol 5.77 mmol/L, low-density lipoprotein 3.93 mmol/L). Magnetic resonance imaging showed diffuse thickening of both Achilles tendons. After thorough discussion and informed consent, the patient underwent total xanthoma excision combined with Achilles tendon reconstruction using a LARS artificial ligament. At the 2-year follow-up, the patient reported no pain or swelling, achieved a VAS score of 0 and an AOFAS score of 90, and demonstrated full recovery of muscle strength and joint motion without clinical or radiological signs of recurrence or foreign body reaction. CONCLUSIONS: Total excision combined with Achilles tendon reconstruction using a LARS artificial ligament might offer a potential alternative for patients with Achilles tendon xanthoma who have high functional demands, considering its avoidance of donor site morbidity, early postoperative recovery, and sufficient biomechanical strength.