Summary

Satisfactory and comparable results and complications were demonstrated when comparing isolated endoscopic FHL tendon transfer or percutaneous Achilles tendon repairs in the surgical management of acute Achilles tendon ruptures, although a slightly significant tendency towards an earlier return to preinjury levels of activity in the FHL group especially at nine months postoperatively.

Abstract

Background

Both percutaneous and endoscopically assisted methods are reported to produce good results in the surgical management of Acute Achilles tendon ruptures (AATR). The aim of this retrospective study was to compare 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.

Methods

One hundred and seventeen patients were included in the current study including two groups: 59 patients who underwent percutaneous Achilles repair (PAR Group), and 58 patients who underwent isolated endoscopic FHL transfer (FHL Group) were compared . Patients were clinically evaluated using AOFAS Ankle-hindfoot score, ATRS, and ATRA measures. In addition, ankle plantarflexion power, FHL dynamometry, Tegner activity levels and return to previous levels of activity were also documented for all patients.

Results

Nine months after surgery, patients in the FHL transfer group were more likely to be able to return to normal activities ( 91% vs. 73%, p <0.01 ). Thirty months after surgical treatment, we found no difference in ATRS, AOFAS, ATRA, ankle plantarflexion strength, Tegner activity scores between study groups. Overall complications were reported in 6 patients in the FHL group (10.3%) and in 8 patients in the PAR group (13.6%). No major neurovascular or skin complications were encountered.

Conclusion

The current study demonstrated satisfactory and comparable results and complications when comparing isolated endoscopic FHL tendon transfer or percutaneous Achilles tendon repairs in the surgical management of acute Achilles tendon ruptures. A significant tendency towards an earlier return to preinjury levels of activity in the FHL group was observed, especially at nine months postoperatively.
Level of evidence: Level III