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Flexor hallucis longus transfer clinical outcome through a single incision for chronic Achilles tendon rupture

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Abstract

Purpose

The aim of this study is to evaluate the clinical outcome of single-incision flexor hallucis longus tendon transfer in chronic Achilles tendon rupture.

Methods

A prospective study of a series of cases of chronic Achilles tendon rupture that were treated with single-incision flexor hallucis longus tendon transfer, from April 2015 to December 2016. The study included 21 patients (15 men and 6 women), with mean age 40.3 ± 17.5 years. The average follow-up time was 15 (12–24) months. Flexor hallucis longus transfer was fixed with a titanium interference screw in an intraosseous calcaneal tunnel.

Results

The average operative time was 52.9 ± 8.7 minutes. The AOFAS-hindfoot score was significantly improved from the mean pre-operative value of 57.4 ± 10.3 to mean value of 95.3 ± 4.4 (p value < 0.001). There was no effect on the big toe function. The complication recorded was one superficial wound infection which resolved by dressing and appropriate antibiotic coverage. All patients were satisfied with the results of surgery.

Conclusions

Single-incision flexor hallucis longus transfer for chronic Achilles tendon ruptures is a simple method with minimal morbidity and complications. The technique resulted in great patients’ satisfaction as well as excellent functional and clinical outcomes.

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References

  1. Yeoman TFM, Brown MJC, Pillai A (2012) Early post-operative results of neglected tendo-Achilles rupture reconstruction using short flexor hallucis longus tendon transfer: a prospective review. Foot 22:219–223

    Article  Google Scholar 

  2. Leppilahti J, Puranen J, Orava S (1996) Incidence of Achilles tendon rupture. Acta Orthop Scand 67:277–279

    Article  CAS  Google Scholar 

  3. Wegrzyn J, Luciani J, Philippot R, Brunet-Guedj E, Moyen B, Besse J (2010) Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. Int Orthop 34:1187–1192. https://doi.org/10.1007/s00264-009-0859-1

    Article  PubMed  Google Scholar 

  4. Reddy SS, Pedowitz DI, Parekh SG, Omar IM, Wapner KI (2009) Surgical treatment for chronic disease and disorders of the Achilles tendon. J Am Acad Orthop Surg 17:3–14

    Article  Google Scholar 

  5. Hansen S (1991) Trauma to the heel cord. In: Jahss M (ed) Disorders of the foot and ankle: medical and surgical management, 2nd edn. WB Saunders, Philadelphia, pp 2355–2360

    Google Scholar 

  6. Wapner K, Pavlock G, Hecht P, Naselli F, Walther R (1993) Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle 14(8):443–449

    Article  CAS  Google Scholar 

  7. Gonçalves S, Caetano R, Corte-Real N (2015) Salvage flexor hallucis longus transfer for a failed Achilles repair: endoscopic technique. Arthroscopy Techniques 4(5):e411–e416

    Article  Google Scholar 

  8. Oksanen M, Haapasalo H, Elo P, Laine H (2014) Hypertrophy of the flexor hallucis longus muscle after tendon transfer in patients with chronic Achilles tendon rupture. Foot Ankle Surgery 20:253–257

    Article  Google Scholar 

  9. Hahn F, Meyer P, Maiwald C, Zanetti M, Vienne P (2008) Treatment of chronic Achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings. Foot Ankle Int 29:794–802

    Article  Google Scholar 

  10. Richardson DR, Willers J, Cohen BE, Davis WH, Jones CP, Anderson RB (2009) Evaluation of the hallux morbidity of single-incision flexor hallucis longus tendon transfer. Foot Ankle Int 30(7):627–630

    Article  Google Scholar 

  11. Mahajan RH, Dalal RB (2009) Flexor hallucis longus tendon transfer for reconstruction of chronically ruptured Achilles tendons. J Orthop Surg 17(2):194–198

    Article  Google Scholar 

  12. Coull R, Flavin R, Stephens M (2003) Flexor hallucis longus tendon transfer: evaluation of postoperative morbidity. Foot Ankle Int 24(12):931–934

    Article  Google Scholar 

  13. Mulier T, Rummens E, Dereymaeker G (2007) Risk of neurovascular injuries in flexor hallucis longus tendon transfers: an anatomic cadaver study. Foot Ankle Int 28(8):910–915. https://doi.org/10.3113/FAI.2007.0910

    Article  PubMed  Google Scholar 

  14. Tashjian RZ, Hur J, Sullivan RJ, Campbell JT, DiGiovanni CW (2003) Flexor hallucis longus transfer for repair of chronic Achilles tendinopathy. Foot Ankle Int 24(9):673–676

    Article  Google Scholar 

  15. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353

    Article  CAS  Google Scholar 

  16. Rahm S, Spross C, Gerber F, Farshad M, Buck FM, Espinosa N (2013) Operative treatment of chronic irreparable Achilles tendon ruptures with large flexor hallucis longus tendon transfers. Foot Ankle Int 34(8):1100–1110. https://doi.org/10.1177/1071100713487725

    Article  PubMed  Google Scholar 

  17. Lin Y, Yang L, Yin L, Duan X (2016) Surgical strategy for the chronic Achilles tendon rupture. BioMed Res Int:1416971. https://doi.org/10.1155/2016/1416971

    Google Scholar 

  18. Pintore E, Barra V, Pintore R, Maffulli N (2001) Peroneus brevis tendon transfer in neglected tears of the Achilles tendon. J Trauma 50:71–78

    Article  CAS  Google Scholar 

  19. Den Hartog B (2008) Surgical strategies: delayed diagnosis or neglected Achilles’ tendon ruptures. Foot Ankle Int 29:456–463

    Article  Google Scholar 

  20. Sakaki MH, Godoy-Santos AL, Ortiz RT, Araújo A, Fernandes TD (2014) Flexor hallux tendon transfer: comparative study through double or single approach. Acta Ortop Bras 22(3):140–143. https://doi.org/10.1590/1413-78522014220300846

    Article  PubMed  PubMed Central  Google Scholar 

  21. Will RE, Galey SM (2009) Outcome of single incision flexor hallucis longus transfer for chronic Achilles tendinopathy. Foot Ankle Int 30(4):315–317. https://doi.org/10.3113/FAI.2009.0315

    Article  PubMed  Google Scholar 

  22. Den Hartog BD (2003) Flexor hallucis longus tendon transfer for chronic Achilles tendinosis. Foot Ankle Int 24(3):233–237

    Article  Google Scholar 

  23. Elias I, Raikin SM, Besser MP, Nazarian LN (2009) Outcomes of chronic insertional Achilles tendinosis using FHL autograft through single incision. Foot Ankle Int 30(3):197–204. https://doi.org/10.3113/FAI.2009.0197

    Article  PubMed  Google Scholar 

  24. Hahn F, Maiwald C, Horstmann T, Vienne P (2008) Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus transfer. Clin Biomech 23(1):109–116

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Department, Assiut University Hospitals, PO box: 71526, Assiut, Egypt

    Hossam Abubeih, Mohamed Khaled, Waleed Riad Saleh & Galal Z. Said

Authors
  1. Hossam Abubeih
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  2. Mohamed Khaled
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  3. Waleed Riad Saleh
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  4. Galal Z. Said
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Corresponding author

Correspondence to Hossam Abubeih.

Ethics declarations

This study was approved by the institutional review board (ethical committee) of our institution. Informed consent was obtained from the patients following the guidelines set forth by our institution and by the Declaration of Helsinki and Good Clinical Practice.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Abubeih, H., Khaled, M., Saleh, W.R. et al. Flexor hallucis longus transfer clinical outcome through a single incision for chronic Achilles tendon rupture. International Orthopaedics (SICOT) 42, 2699–2704 (2018). https://doi.org/10.1007/s00264-018-3976-x

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  • DOI: https://doi.org/10.1007/s00264-018-3976-x

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