Acute Achilles tendon rupture (AATR) can be treated with either surgical or nonsurgical options. The flexor hallucis longus (FHL) has been used to augment the Achilles tendon in patients with Achilles tendinosis and large chronic defects. The aim of this study was to describe clinical outcomes of isolated endoscopic FHL transfer in patients with acute Achilles tendon ruptures at a minimum followup period of eighteen months.
Fifty-six male patients with an average age of 36.3 years who underwent endoscopic Flexor Hallucis Longus transfer as a treatment for acute Achilles tendon ruptures were included in this study. Followup was for a median of 27.5 +/-7.29 (range, 18 to 43) months after surgery. Magnetic resonance images were obtained preoperatively, at one week, and one and a half years postoperatively. Also, Hallux dynamometry, Ankle plantar flexion strength, Achilles tendon length using Achilles tendon resting angle (ATRA) in addition to Achilles tendon rupture scores (ATRS), AOFAS and VAS scores were documented for all patients also at 18 months postoperatively. MRI performed at a minimum of eighteen months postoperative showed a homogenous continuous signal for 43 patients, and heterogenous signal intensity in 13 patients (23.21%). ATRS median was 95+/-4.26 , while AOFAS score was a mean of 96.4(+/-4.31). Median value for FHL tendon dynamometry at the surgical side was 95.72 (range 70.1-142) and 100.7 (range 68-161) for the nonoperated side (p<0.001). No patients reported any great toe complaints or symptomatic deficits of flexion strength. No neurovascular or skin complications were encountered.
The current study demonstrated satisfactory and comparable results with minimal complications when utilizing the FHL tendon transfer in acute Achilles tendon ruptures, compared to the currently utilized methods.
Level of evidence: Level II Prospective Cohort Case series study
Key words: Acute achilles rupture; Achilles injury; Achilles tendon tear management; Endoscopic Flexor Hallucis Longus tendon transfer; Achilles tendon management.