scholarly journals Early Postoperative Results of Endoscopic Transfer of Flexor Hallucis Longus for Chronic Achilles Rupture

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Daniel Baumfeld ◽  
Fernando Raduan ◽  
Caio Nery ◽  
Benjamim Macedo ◽  
Thiago Silva ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Invasive Technique ◽  
Flexor Hallucis Longus ◽  
Open Procedure ◽  
Wound Healing Problems ◽  
Major Increase ◽  
Chronic Injuries

Category: Ankle, Arthroscopy, Hindfoot Introduction/Purpose: Background Achilles tendon chronic rupture lead to proximal retraction of the tendon and have a greater tendency to show poorer functional outcomes than acute ruptures. Numerous surgical procedures have been described to treat this pathology. The transfer of the flexor hallucis longus is a well-established treatment option, usually performed as an open procedure. The aim of this paper is to report a case series of six patients with chronic Achilles tendon rupture treated with endoscopic transfer of FHL. Methods: Six patients with Achilles tendon chronic injuries or re-ruptures were treated with endoscopic FHL transfer. There were four man and two women, average of 50 years, with four left and two right tendons involved, and no bilateral cases. All lesions were at zone 2 (between 2-6 cm proximal to insertion). We describe the surgical technique and report our results at an average of a nine-month follow-up. Results: The average follow-up of the series was 9 months (range, 5–12 months). Three patients had an associate procedure at the Achilles tendon to repair the pre-existent gap, using a minimally invasive technique. On average, we expend 56 minutes to perform the surgery, ranging from 45 to 70 minutes. All patients had a major increase in ATRS score values postoperatively, with an average of 17.8 preoperatively and 83,3 postoperatively No major complications or wound healing problems were noted. Tiptoe stance was possible for all patients without limitation. None of the patients noticed functional weakness of the hallux during daily life activity. Conclusion: Endoscopic FLH transfer is a reliable option for patients with higher skin risk and soft tissue complications. Other studies are needed to compare this technique with the open procedure, gold standard by now, to ensure its safety and efficacy.

Dual Purpose Use of Flexor Hallucis Longus Tendon for Management of Chronic Achilles Tendon Ruptures

2018 ◽  
Vol 12 (4) ◽  
pp. 345-349
Author(s):  
Mohammed A. Khalid ◽  
William M. Weiss ◽  
Michael Iloanya ◽  
Vinod K. Panchbhavi
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Invasive Technique ◽  
Flexor Hallucis Longus ◽  
Aofas Score ◽  
Excellent Outcome ◽  
Longus Tendon ◽  
Tendon Ruptures

Background: Chronic Achilles tendon ruptures are uncommon and increase long-term morbidity when untreated. There is no standard treatment for this condition. Methods: Chronic Achilles tendon rupture was repaired in 10 patients by harvesting the flexor hallucis longus tendon (FHL) using a minimally invasive technique. It was then transferred to the calcaneus and the remnant used to bridge the gap for reconstructing the Achilles tendon itself. The patients were assessed using the American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot Scale. Results: Patients were evaluated postoperatively to assess pain, function, and alignment of the ankle and hindfoot. Average follow-up time was 30.9 months (range = 17-43 months). The average postoperative AOFAS score was 78.5 (range = 54-94). The average postoperative score for pain was 33.5 out of 40; for function, 38.7 out of 50; and for alignment, 6.3 out of 10. A single surgical site infection requiring Incision and Drainage (I&D) was the only operative complication noted. No patient developed a significant deformity of the hallux after transfer. Conclusions: FHL transfer using a minimally invasive harvest for the treatment of chronic Achilles tendon ruptures produces good to excellent outcome measures as judged by an AOFAS score of 75 or greater while minimizing risk to the medial neurovascular bundle. Levels of Evidence: Case series, Level IV: Retrospective

Endoscopic Transfer of Flexor Hallucis Longus Tendon for Chronic Achilles Tendon Rupture: Technical Aspects and Short-Time Experiences

2018 ◽  
Vol 11 (5) ◽  
pp. 461-466 ◽  
Author(s):  
Elisabeth Ellingsen Husebye ◽  
Marius Molund ◽  
Kjetil Harald Hvaal ◽  
Are Haukåen Stødle
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Achilles Tendon ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Flexor Hallucis Longus ◽  
Flexor Hallucis Longus Transfer ◽  
Soft Tissue Dissection ◽  
Wound Healing Problems

Background. Chronic Achilles tendon ruptures can lead to reduced power of plantar flexion in the ankle with impaired gait ability. The open 1- or 2-incision technique for flexor hallucis longus transfer has proven good functional outcome but has the disadvantage of relatively extensive surgery performed at a vulnerable location. To reduce the risk of soft tissue problems, the flexor hallucis longus transfer can be performed endoscopically. Material and Method. An endoscopic technique for flexor hallucis longus transfer is presented together with the experiences from the first six patients operated with this method. Results. No wound healing problems or infections. Five of 6 patients managed single leg heel raise on the affected side 12 months after surgery. Conclusion. The functional results are promising. The soft tissue dissection is minor, and no patients had postoperative wound healing problems or infection. Endoscopic flexor hallucis longus transfer may be an operative procedure that can be considered also in patients with potential wound healing problems. Levels of Evidence: Level IV: Technical note/case series without controls

Endoscopic Flexor Hallucis Longus Transfer for Chronic Noninsertional Achilles Tendon Rupture

2018 ◽  
Vol 39 (12) ◽  
pp. 1464-1472 ◽  
Author(s):  
Jordi Vega ◽  
Jesus Vilá ◽  
Jorge Batista ◽  
Francesc Malagelada ◽  
Miki Dalmau-Pastor
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Flexor Hallucis Longus ◽  
Level Of Evidence ◽  
Wound Breakdown ◽  
Tendon Ruptures

Background: Operative management of chronic Achilles tendon ruptures is challenging, and numerous techniques have been described. Risk of infection and wound breakdown have been described after open techniques, and minimally invasive methods have been proposed to avoid them. The aim of this study was to describe the clinical and radiological results obtained after endoscopic flexor hallucis longus (FHL) tendon transfer in patients with chronic Achilles tendon rupture. Methods: Between 2012 and 2015, a total of 22 patients were endoscopically treated for chronic Achilles tendon rupture. Mean age was 69 years (range, 59-84 years). Mean follow-up was 30.5 months (range, 18-46 months). Preoperative magnetic resonance imaging (MRI) was obtained and tendon gap measured. An MRI was obtained at 9 to 12 months following surgery to evaluate Achilles tendon changes. Results: Preoperative MRI examination showed a mean tendon gap of 6.3 cm (range, 3-10.7 cm). The MRI control was obtained only in 12 patients, and a normal or close to normal Achilles tendon was observed in all but 1 patient. The mean American Orthopaedic Foot & Ankle Society score increased from 55 preoperatively (range, 26-75) to 91 (range, 74-100) at final follow-up. All patients returned to their daily activities without difficulties. No patients reported complaints or symptomatic deficits of great toe flexion strength. No major complications were encountered. Conclusion: Chronic Achilles tendon ruptures were successfully treated by an all-endoscopic procedure. The endoscopically assisted FHL transfer provided excellent results while benefiting from the minimally invasive procedure advantages. However, it entailed some technical challenges and may not be suitable for less experienced surgeons. Level of Evidence: Level IV, retrospective case series.

scholarly journals Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Keisuke Tsukada ◽  
Youichi Yasui ◽  
Maya Kubo ◽  
Shinya Miki ◽  
Kentaro Matsui ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Scale Score ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Semitendinosus Tendon ◽  
Level Of Evidence ◽  
Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

scholarly journals Achilles tendon repair by a minimally invasive technique using Tenolig®

2020 ◽  
Vol 14 (3) ◽  
pp. 269-273
Author(s):  
Vinicius Oliveira ◽  
Sérgio Prata
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Postoperative Infection ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Aofas Score ◽  
Functional Scores

Objective: To assess the degree of postoperative satisfaction of patients with acute Achilles tendon rupture who underwent surgical reconstruction by a minimally invasive technique using Tenolig®. Methods: A retrospective observational study was conducted with 18 patients with acute Achilles tendon rupture diagnosed by a positive Thompson test who underwent surgery. Outcomes were assessed using the American  arthopaedic Foot and Ankle Society (AOFAS) score and the Foot Function Index (FFI). Furthermore, quantitative variables were descriptively treated, and patients’ age was correlated with FII and AOFAS score using Spearman’s correlation coefficient at a significance level of 5%. Results: Patients underwent surgery from one to six days after injury and were discharged one day later. Only one patient had a superficial postoperative infection. Patients’ AOFAS scores ranged from 75 to 100 points, and FFI ranged from 0 to 20%. The patient withsuperficial postoperative infection had an AOFAS score and a FFI of 75 points and 20%, respectively. Conclusion: Percutaneous repair of complete Achilles tendon rupture with Tenolig® resulted in high functional scores and a low rate of complications. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Gait Function and Postural Control 4.5 Years After Nonoperative Dynamic Treatment of Acute Achilles Tendon Ruptures

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985432 ◽  
Author(s):  
Merete B. Speedtsberg ◽  
Rasmus Kastoft ◽  
Kristoffer W. Barfod ◽  
Jeanette Ø. Penny ◽  
Jesper Bencke
Keyword(s):  
Achilles Tendon ◽  
Center Of Pressure ◽  
Dynamic Stiffness ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Tendon Length ◽  
Balance Task ◽  
Achilles Tendon Length

Background: An Achilles tendon rupture (ATR) is known to cause persistent biomechanical deficits such as decreased muscle strength in end-range plantar flexion and reduced tendon stiffness. Purpose/Hypothesis: This study aimed to examine whether sustained asymmetries were present in dynamic stiffness and kinematic and kinetic variables in gait and single-leg balance at 4.5-year follow-up in conservatively treated patients recovering from an ATR. We hypothesized that patients who had recovered from ATRs exhibit a midterm increase in peak ankle dorsiflexion, a decrease in concentric work, and decreased dynamic stiffness during the stance phase of gait, along with increased single-leg standing sway in the injured leg compared with the uninjured leg. Study Design: Case series; Level of evidence, 4. Methods: This study was a cross-sectional medium-term follow-up of conservatively treated patients recovering from ATRs. A total of 34 patients who underwent nonoperative treatment were included for testing 4.5 years after a rupture. The Achilles tendon length was measured using ultrasound. Standard instrumented 3-dimensional (3D) gait analysis and single-leg standing balance were performed using 3D motion capture. Kinematic and kinetic ankle parameters were calculated during gait, and quasi-stiffness was calculated as the moment change per the change in the degree of dorsiflexion during the second (ankle) rocker of the gait cycle. Center of pressure displacement (sway length), along with rambling and trembling, was calculated for the single-leg balance task. Results: Peak dorsiflexion in stance was 13.4% larger in the injured leg than the uninjured leg (16.9° ± 3.1° vs 14.9° ± 0.4°, respectively; P ≤ .001). Peak dorsiflexion was not associated with the normalized Achilles tendon length (B = 0.052; P = .775). Total positive work in the plantar flexors was 23.9% greater in the uninjured leg than the injured leg (4.71 ± 1.60 vs 3.80 ± 0.79 J/kg, respectively; P = .001). Quasi-stiffness was greater in the uninjured leg than the injured leg during the initial (0.053 ± 0.022 vs 0.046 ± 0.020 N·m/kg/deg, respectively; P = .009) and late (0.162 ± 0.110 vs 0.139 ± 0.041 N·m/kg/deg, respectively; P = .005) phases of eccentric loading. No difference was found in sway length during single-leg stance between the injured and uninjured legs (1.45 ± 0.4 vs 1.44 ± 0.4 m, respectively; P = .955). Conclusion: Patients treated conservatively have a small increase in peak dorsiflexion, decreased total concentric plantar flexor power, and decreased quasi-stiffness in initial and end-range dorsiflexion in the injured leg. These deviations could not be directly associated with the measured tendon elongation. Registration: NCT02760784 ( ClinicalTrials.gov ).

Direct Plantar Approach to Henry's Knot for Flexor Hallucis Longus Transfer

2012 ◽  
Vol 33 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Michael Amlang ◽  
Maria C. Rosenow ◽  
Adina Friedrich ◽  
Hans Zwipp ◽  
Stefan Rammelt
Keyword(s):  
Achilles Tendon ◽  
Case Series ◽  
Contralateral Side ◽  
Flexor Hallucis Longus ◽  
Distal Stump ◽  
Level Of Evidence ◽  
Medial Plantar Nerve ◽  
Flexor Hallucis Longus Transfer ◽  
Wound Healing Problems ◽  
Flexor Digitorum

Background: Transfer of the flexor hallucis longus (FHL) tendon is an established method to replace a dysfunctional Achilles tendon. When using a single incision, the FHL tendon has to be transferred as a single stranded graft into the calcaneus and the distal FHL stump cannot be directly attached to the flexor digitorum longus tendon (FDL). Another concern with tendon retrieval is neurovascular damage. We report our results with a direct plantar approach for tendon harvest. Methods: A direct plantar approach to the master knot of Henry with reattachment to its distal stump while protecting the medial plantar nerve was used allowing a double stranded FHL-transfer in 25 cases of a severely dysfunctional Achilles tendon in 24 consecutive patients. Patients were evaluated prospectively and at an average followup of 73 (range, 20 to 121) months. Results: No wound healing problems and no lesion of the medial plantar nerve occurred. The subjective result was rated as excellent in 18 (72%), good in five (20%), and fair in one case (8%). The AOFAS hindfoot score averaged 95.4 (range, 61 to 100) points and the AOFAS hallux score averaged 97.6 (range, 87 to 100) points. No loss of plantarflexion force was observed in the big toe as compared to the contralateral side. Conclusion: The plantar approach to Henry's knot allowed the use of a double stranded FHL transplant. The distal stump was attached to the FDL tendon to preserve flexion at the great toe without damaging to the medial plantar nerve. Level of Evidence: IV, Case Series

scholarly journals Clinical Outcomes in Patients With Minimally Invasive Surgical Approach Combined With Plantar Tendon Transfer Repairing Neglected Achilles Tendon Rupture Compared to the Conventional Approach of V-Y Tendon Plasty: A Retrospective Study With Two Years Follow-Up

2021 ◽  
Author(s):  
Feiyu Cai ◽  
Kai Liu ◽  
Yanshi Liu ◽  
Biao Luo ◽  
Pengfei Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Neglected Achilles Tendon Rupture ◽  
Group A ◽  
Group B

Abstract Background Unlike acute Achilles tendon rupture (AATR), neglected Achilles tendon rupture (NATR) requires usually tendon grafting procedures for repair tendon defects caused by removing scar tissue. The conventional open surgery of V-Y tendon plasty and minimally invasive technique with plantar tendon transfer had been described, but the long-term efficacy between the two techniques still needs further certification. Methods Between February 1, 2008, and July 31, 2018. All of 46 patients with neglected Achilles tendon rupture, 25 patients in group A (21 males and 4 females; age, 34.28 ± 6.97 years) underwent the conventional operation of V-Y tendon plasty, and 21 patients in group B (14 males and 7 females; age, 35.29 ± 7.42 years) were treated by the minimally invasive technique. Two years follow-up was performed for the functional recovery with examinations of the Achilles tendon rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hind-Foot Scale Score, dorsiflexion, calf circumference, and heel raise test. Results Patient characteristics between the two groups were similar. The functional score of ATRS and AOFAS in Group B was higher than patients in group A at postoperative months 3, 6, and 12, while there is no difference at month 24. In group A, there were three patients exposed to soft tissue infections (two superficial infections and one deep infection) and one case with tendon exposure. In group B, a patient with tendon re-rupture was observed. There was no difference in dorsiflexion and calf circumference at follow-up two years and the much better recovery in heel raise test group B than A. Conclusions Two different techniques produced a significant functional improvement, and return to sports. However, this study demonstrated that the minimally invasive technique was recommended for patients with a tendon defect less than 6 cm and who have an urgent demand to return to the sports.

Sign in / Sign up

Export Citation Format

Share Document