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Endoscopic Flexor Hallucis Longus Tendon Transfer As a Treatment Modality In Acute Achilles Tendon Rupture. A Case Series With A Minimum of 6 Months of Follow-Up


Michail Kotsapas, MD, MSc
GREECE

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Endoscopic Flexor Hallucis Longus Tendon Transfer As a Treatment Modality In Acute Achilles Tendon Rupture. A Case Series With A Minimum of 6 Months of Follow-Up

Michail Kotsapas, MD, MSc, GREECE Apostolos Polyzos, MD, GREECE Ioannis Vasiadis, MD, GREECE Alexandros Eleftheropoulos, MD, GREECE

Department of Trauma and Orthopaedics, Naousa's General Hospital, Naousa, GREECE

2023 Congress   ePoster Presentation   2023 Congress   Not yet rated

 

Anatomic Location

Ankle / Foot / Calf

Anatomic Structure

Tendon Muscle

Diagnosis / Condition

Tears

Treatment / Technique

Endoscopy Arthroscopy

Patient Populations

Elderly Professional Athletes / Olympians Sport Specific Population

Diagnosis Method

Physical Examination MRI

Sports Medicine

Outcome Studies

Tendon

Rupture Tendon Achilles Tendon

Summary: Our purpose is to present a case series of 25 patients with acute Achilles tendon rupture managed with endoscopic Flexor Hallucis Longus (FHL) tendon transfer.

Between 2014 and 2022, 25 patients (18 male – 7 female) with acute Achilles tendon rupture underwent endoscopically assisted FHL tendon transfer to the calcaneus with the following technique:
The patient is placed in a prone position with a soft bump under the ipsilateral calf; a thigh tourniquet is applied. The leg is prepped with a disinfectant agent and draped with a waterproof fenestrated drape. A posterolateral (viewing) and a posteromedial (working) portal are established on either side of the torn Achilles tendon at the height of the tip of the lateral malleolus. After adequate debridement, FHL is identified, released from its sheath and fascia, and mobilized. The next step is FHL tendon harvesting with the tendon stripper. The proximal FHL tendon stump is withdrawn outside the posteromedial portal, an absorbable suture is applied, and the diameter of the tendon stump is measured. Through a small posterior midline plantar incision, a guidewire is inserted as posterior and medial as possible in the calcaneus. Its position is confirmed under fluoroscopy. A tunnel is established with a cannulated drill. The tendon stump is fixed in the calcaneal tunnel with an interference screw. The approximation of the Achilles tendon stumps is confirmed endoscopically. After skin closure, a below-knee cast in gravity equinus is applied for two weeks. All patients receive antibiotics and antithrombotic prophylaxis. A physiotherapy protocol focused on early weight-bearing with functional rehabilitation is suggested for all patients.
Patient satisfaction was assessed with “The Achilles tendon Total Rupture Score”, with a mean score of 86,8±17,4. All the patients underwent an MRI control in six months post-op.
Minor complications were reported in 2 patients (one stiffness and one intraoperative screw breakage). Passive and active range of motion and calf and ankle circumference were also recorded and assessed. No significant complications were noticed.
In conclusion, arthroscopic FHL tendon transfer for acute Achilles tendon rupture is a reliable and safe treatment modality with excellent results.

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