Summary

We present a small group of recreational athletes and high demand workers in which the endoscopic transfer of Flexor Hallucis Longus for Chronic Achilles Rupture had good results with remarkable functional rehabilitation. The results were comparable to the open technique, with less invasion and soft tissue complications.

Abstract

Introduction

Chronic Achilles Tendon Rupture (CATR) is still a prevalent pathology that includes neglected ruptures with more than 6-8 weeks and re-ruptures after surgical treatment. CATR cause marked functional impairment that usually requires surgical repair and an open procedure is traditionally performed. The endoscopic treatment has been described but there is no consensus in its usage due to lack of quality papers. There is some experience with endoscopic transfer of Flexor Hallucis Longus (ETFHL) but most authors recommended this technique only on low demanding patients.
The purpose of this paper is to present our results with ETFHL on athletic patients (recreational sports or high demanding job), contributing to the establishment of this technique.

Material And Methods

In this retrospective study, the authors report a series of 14 patients submitted to ETFHL, 12 patients due to Chronic Achilles rupture and 2 due to acute re-rupture, between May 2014 and February 2018. The mean follow-up period was 28 months (range 6 to 48 months). We recorded the pre-operative AOFAS and ATRS score as well as post-operative AOFAS Score, ATRS and Heel Rise Height test.

Results

In our 14 patients (11 male, 3 female) the mean age was 42 years old (range 23 to 59). There were 10 non-professional athletes and 4 high demand workers. The mean pre-operative AOFAS score was 61,1 (range 49 to 79) and ATRS was 11,6 (range 10 to 14).
Post-operative results: the mean AOFAS Score was 98 (ranging 90 to 100). All patients were able to do single foot Heel Rise with a mean Heigh of 9,2 cm (range 8 to 12 cm). ATRS mean was 95 (range 81 to 100). Ten out of 10 patients returned to sports at the same level. One patient had transient hypoesthesia of tibial nerve. No other complications where registered.

Discussion

We present a small group of recreational athletes and high demand workers in which the ETFHL for CATR had good results with remarkable functional rehabilitation. All of our patients returned to previous level of sports or work activity. By the end of follow-up they showed almost complete functional recuperation of the gastrocnemius complex.
This technique shows good results, comparable to the open technique, with less invasion and soft tissue complications. Our experience made us believe that the ETFHL may play a role in the treatment of CATR, not only on low demand patients but also in the athletic population. Further studies are necessary to compare this technique with the open procedure to ensure its safety and efficacy.