Objectives
To present our early results after using this modified endoscopic - hybrid technique for the treatment of acute Achilles tendon ruptures.
Methods
Between 2014 and 2018, 17 patients with acute Achilles tendon ruptures were admitted in our department. 11 males and 6 females with a mean age of 47 years (24 to 78). Patients with co-morbidities like obesity and diabetes mellitus were not excluded.
The diagnosis was established using clinical and imaging tests, like the Squeeze test and Magnetic Resonance Imaging(MRI). All patients underwent a hindfoot endoscopy including an endoscopic inspection and identification of the acute Achilles tendon rupture.
The Flexor Hallucis Longus(FHL) tendon was identified, was harvested (endoscopically), and got prepared. Under fluoroscopic and endoscopic guidance the stump of FHL was transferred to os calcis just proximal and medial to Achilles tendon insertion. It was transfixed in a 6-7 mm intraosseous tunnel using a 7-8 mm bioabsorbable screw, with the foot in full plantar flexion position.
The end to end approximation of Achilles tendon stumps was checked endoscopically and a below-knee back slab was positioned for two weeks time.
An aggressive physio program was undertaken as soon as the cast was removed. Partial weight-bearing started in 2/52 time postoperatively and full weight-bearing in 4/52 time post-op, with the use of a removable below knee boot. Follow up was at least for 18 months. All data were obtained by recalling each patient for physical examination the 2nd and 6th week and the 3rd,4th,6th,12th, and 18th month postoperatively. During those visits in all patients, Achilles tendon rupture score was used and the active range of motion of the ankle was calculated in the prone position. In the 12th month, a new MRI of the operated foot was obtained.
Results
No major complication like wound infection or failure of the tendon transfer was recorded. Healing of the ruptured Achilles tendon was achieved in all cases.
All the patients return to their normal daytime activities after 8 to 10 weeks time. Single heal rise was achieved after 4 months' time.
Sporting activities were allowed after the 5th month postoperatively. Also, statistical analysis showed that there was not a statistically significant difference between the ankles at the 6th,12th, 18th-month visit.
Conclusions
The use of FHL tendon as an "internal spring", seems that inspire the patients and the physio team and gives them more confidence regarding the approximation of the Achilles tendon stumps. All patients declared that they could control their ankle easily and confidently immediately after the endoscopic reconstruction just as they could before the rupture. The satisfaction rate was high, even in the young population.