ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper


Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Isolated Endoscopic Flexor Hallucis Longus Tendon Transfer in the Management of Acute Achilles Tendon Ruptures. A Retrospective Case Series Report with a Minimum of 30 Month

Nasef Mohamed N. Abdelatif, MD, PhD, Cairo, Maadi EGYPT
Jorge Pablo Batista, MD, San Isidro, Buenos Aires ARGENTINA

DrNasef OrthoClinic, Centro Arthroscopia Jorge Batista, Cairo, Buenos Aries, EGYPT

FDA Status Cleared


The current study demonstrated satisfactory and almost equally comparable results with minimal complications in patients with acute achilles ruptures when treated by both methods.



The definitive management for Acute Achilles tendon ruptures (AATR) is yet to reach a final consensus. Both percutaneous and endoscopically assisted methods have been reported to produce good results in the surgical management of this injury. The aim of this study was to compare the clinical results between a percutaneous method and a recently described isolated endoscopically assisted Flexor hallucis longus (FHL) transfer method as surgical means of management in patients with acute Achilles tendon ruptures at a minimum followup period of thirty months.


One hundred and seventeen patients with an average age of 36.25 years were primarily included in the current study. These were divided into two groups: patients who underwent percutaneous repair using PARS? instrumentation system (PARS Group), and another group who underwent isolated endoscopic FHL transfer (FHL transfer Group) for treatment of AATR. The followup period of both study groups was for a mean of 42.54 months. Overall, three patients were lost in followup. Ultimately the PARS group consisted of 59 patients and the FHL transfer group of 58 patients. There were no statistical differences in demographics between both these study groups. Both groups received the same postoperative rehabilitation protocol. Both groups were clinically evaluated using AOFAS Ankle-hindfoot score, ATRS, and ATRA measures. In addition, ankle plantarflexion power, FHL dynamometry and Tegner activity levels were also documented for all patients. Return to previous levels of activities was also documented for all included cases.


At 30 months postoperatively, ATRS, AOFAS, ATRA, ankle plantarflexion strength, and Tegner activity scores showed no statistical significance across both study groups. Overall complications were reported in 6 patients in the FHL group (10.3%) and in 8 patients in the PARS group (13.6%). MRI performed at a minimum of thirty months postoperative showed a homogenous continuous achilles tendon signal for 43 patients, and heterogenous signal intensity in 13 patients (23.21%). Ultimately, 54 patients and 53 patients returned to their same level of activity in the FHL (93.1%) and PARS groups (89.8%) respectively. No patients reported any great toe complaints or symptomatic deficits of flexion strength. No major neurovascular or skin complications were encountered.


The current study demonstrated satisfactory and comparable results with minimal complications when comparing the utilization of isolated endoscopic FHL tendon transfer or percutaneous PARS? achilles tendon repairs in the surgical management of acute Achilles tendon ruptures.

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