The functional and dynamometer-tested results of transtendinous flexor hallucis longus transfer for neglected ruptures of the Achilles tendon at six years’ follow-up

2018 ◽  
Vol 100-B (5) ◽  
pp. 584-589 ◽  
Author(s):  
C. J. Lever ◽  
H. A. Bosman ◽  
A. H. N. Robinson
Keyword(s):  
Achilles Tendon ◽  
Plantar Flexion ◽  
Contralateral Side ◽  
Triceps Surae ◽  
Wound Complications ◽  
Flexor Hallucis Longus ◽  
Flexor Hallucis Longus Transfer ◽  
The Mean ◽  
American Orthopaedic

Aims Flexor hallucis longus (FHL) tendon transfer is a well-recognized technique in the treatment of the neglected tendo Achillis (TA) rupture. Patients and Methods We report a retrospective review of 20/32 patients who had undergone transtendinous FHL transfer between 2003 and 2011 for chronic TA rupture. Their mean age at the time of surgery was 53 years (22 to 83). The mean time from rupture to surgery was seven months (1 to 36). The mean postoperative follow-up was 73 months (29 to 120). Six patients experienced postoperative wound complications. Results The mean postoperative Achilles tendon Total Rupture Score (ATRS) was 83 (40 to 100) and the mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 94.3 (82 to 100). Tegner scoring showed a mean reduction of one level from the pre-injury level of activity. There was a mean reduction of 24% (4 to 54) in dynamometer-measured strength of ankle plantarflexion, in comparison with the non-operated side. The hallux had a mean of only 40% (2 to 90) strength of plantarflexion in comparison with the contralateral side. Conclusion We conclude that transtendinous FHL transfer for neglected TA ruptures, with a long harvest to allow reattachment of the triceps surae, provides reliable long-term function and good ankle plantarflexion strength. Despite the loss of strength in hallux plantar flexion, there is little comorbidity from the FHL harvest. Cite this article: Bone Joint J 2018;100-B:584–9.

scholarly journals Minimally invasive treatment of acute Achilles tendon rupture with endoscopic flexor hallucis longus transfer

2019 ◽  
Vol 13 (2) ◽  
pp. 129-134
Author(s):  
Thiago Coelho Paim Lima ◽  
Rodrigo Gonçalves Pagnano ◽  
Gustavo Eiji Nodu Sato ◽  
Carolina Lins ◽  
Mauro Cesar Mattos e Dinato
Keyword(s):  
Achilles Tendon ◽  
Functional Outcomes ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Contralateral Side ◽  
Flexor Hallucis Longus ◽  
Flexor Hallucis Longus Transfer ◽  
The Mean ◽  
Flexion Strength

Objective: To evaluate the clinical and functional outcomes of acute Achilles tendon rupture or rerupture repaired with minimally invasive surgery and reinforcement with flexor hallucis longus transfer via posterior ankle arthroscopy in patients with poor compliance with follow-up. Methods: A retrospective study was conducted that evaluated five patients with more than 24 months of postoperative follow-up using the American Orthopaedic Foot and Ankle Society (AOFAS) scale, Victorian Institute of Sport Assessment-Achilles (VISA-A) scale, Achilles tendon total rupture score (ATRS), and visual analog scale (VAS) for pain, as well as the range of motion and flexion strength. Results: The mean scores on the VAS, AOFAS scale, and VISA-A scale and the ATRS were 0.6, 98, 98.2, and 100, respectively. The mean dorsiflexion range of motion was 4.8° on the operated side and 7.6° on the contralateral side. The mean plantar flexion strength was 24.02 kgf on the operated side and 24.64 kgf on the contralateral side. The flexion strength of the interphalangeal joint of the hallux was 13.94 kgf on the operated side and 17.6 kgf on the contralateral side. The patients had no functional complaints. Conclusion: The proposed surgical treatment had good clinical and functional outcomes in the evaluated patients. The surgical technique described may be a good alternative for treating patients with poor compliance diagnosed with acute tendon rupture or cases of rerupture. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Sport and physical activities in patients with Chronic Achilles tendon rupture reconstruction using flexor hallucis longus transfer

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0033
Author(s):  
Luigi Manzi ◽  
Camilla Maccario ◽  
Ariel Palanca ◽  
Claudia Di Silvestri ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Wound Complications ◽  
Flexor Hallucis Longus ◽  
Distal Stump ◽  
Flexor Hallucis Longus Transfer ◽  
Patient Reported ◽  
Ucla Score ◽  
Activity Scale

Category: Sports Introduction/Purpose: Neglected or chronic Achilles tendon ruptures can be significantly disabling to patients if the muscle-tendon unit is stretched beyond its normal passive limit. Chronic rupture of the Achilles tendon (delayed diagnosis of more than 4 weeks) can result in retraction of the tendon and inadequate healing. Direct repair may not be possible and clinical results may not be satisfactory especially if the distal stump is grossly tendinopathic and when the defect exceeds 5-6 cm. Methods: We evaluated 9 patients (mean age 63) who underwent flexor hallucis longus transfer for treatment of chronic Achilles tendinopathy between May 2014 and January 2017 at a 12 months follow-up. Our results were measured with the SF-12 survey, AOFAS Ankle-Hindfoot Scale and VAS. Activity levels were determined using the Halasi ankle activity scale and the UCLA score obtained preoperatively and 12 months after surgery. Wound complications and tip-toe stance were also assessed. Results: All patients had a significant improvement of AOFAS, VAS and SF-12 scores. The Halasi activity scale and UCLA score were 5.8 and 8.2 respectively 12 months after surgery. Patient reported outcome measures consistently demonstrated improvement in clinical putcomes at 12 months follow-up. The patients went back to full daily function, could single leg heel raise and were gradually returning to sport. No major complications were recorded. Conclusion: Reconstruction of chronic tears of the Achilles tendon with flexor hallucis longus transfer can achieve satisfactory improvements in clinical outcomes at 1 year follow-up.

scholarly journals Results of tenorrhaphy with early rehabilitation for acute tear of Achilles tendon

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880248 ◽  
Author(s):  
Chang Hyun Ryu ◽  
Ho Seong Lee ◽  
Sang Gyo Seo ◽  
Ho Yeon Kim
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Early Rehabilitation ◽  
Calf Circumference ◽  
Major Complications ◽  
The Mean

Background: For the treatment of acute Achilles tendon rupture, early rehabilitation after surgical repair is believed to be a useful method. The purpose of this study was to evaluate the outcome of open tenorrhaphy followed by early rehabilitation. Methods: A total of 112 patients who underwent open repair and early rehabilitation for acute Achilles tendon rupture from January 2003 to March 2015 were retrospectively reviewed. These 112 patients (80 men, 32 women) had an average age of 43.1 years (22–62 years), and the mean follow-up period was 91.8 months (12–171 months). A short leg cast was applied postoperatively for an average of 16.5 days (12–20 days). The mean duration of bracing was 6.9 weeks (6–8 weeks). Each patient was assessed based on range of motion, single heel raising test, calf circumference compared to the contralateral limb, ability to return to previous activity, the Arner–Lindholm scale, and the American orthopaedic foot and ankle society (AOFAS) hind foot scale. Isokinetic plantar flexion power was also checked. Results: All patients were fully satisfied (AOFAS ≥ 90) with the treatment results, and 96 patients were able to return to their previous athletic activities. As assessed by the Arner–Lindholm scale, 103 cases were rated as excellent and the other 9 cases were rated as good. At the 1-year follow-up period, single heel raise and hopping was possible in every patient. Compared to the contralateral side, 10 subjects (8.9%) had minor limitation of dorsiflexion motion, and an average of 1.6 cm calf circumference difference without functional disabilities. There were no major complications such as re-rupture, nerve injury, or infection. Conclusion: For acute Achilles tendon ruptures, open surgical repair with optimal length restoration, followed by earlier rehabilitation results in good functional outcomes and a successful return to pre-injury levels of physical activity without major complications. Level of evidence: Level IV.

scholarly journals Flexor Hallucis Longus Tendon Transfer for Reconstruction of Chronically Ruptured Achilles Tendons

2009 ◽  
Vol 17 (2) ◽  
pp. 194-198 ◽  
Author(s):  
Ravindra H Mahajan ◽  
Rakesh B Dalal
Keyword(s):  
Wound Healing ◽  
Tendon Transfer ◽  
Flexor Hallucis Longus ◽  
Related Complication ◽  
Hind Foot ◽  
The Mean ◽  
American Orthopaedic ◽  
One Year

Purpose. To report the mid-term results of flexor hallucis longus (FHL) tendon transfer for reconstruction of chronically ruptured Achilles tendons. Methods. 24 men and 12 women aged 56 to 78 (mean, 70) years underwent FHL tendon transfer for reconstruction of chronically ruptured Achilles tendons by a single surgeon. Ruptures were secondary to trauma (n=20), long-term steroid intake (n=12), or chronic renal failure (n=6). Two patients had bilateral ruptures. The mean interval from rupture to surgery was 15 (range, 12–24) weeks. Pre- and post-operative American Orthopaedic Foot and Ankle Society (AOFAS) hind foot scores were compared. Wound healing, push-off, and patient satisfaction were evaluated. Results. The mean follow-up period was one year. The mean AOFAS scores were 69 (range, 58–76) preoperatively and 88 (range, 79–94) postoperatively; the mean improvement was 19 (p<0.001). 28 patients had excellent and 8 had fair results. 33 patients graded their outcome as ‘very satisfactory’ and 3 as ‘satisfactory’. Five patients developed wound healing complications but only one needed debridement. There was no fixation-related complication or sural nerve injury. Conclusions. Transfer of the FHL for reconstruction of chronically ruptured Achilles tendons is effective, safe and easily performed in patients with low-to-moderate demands.

scholarly journals PO 18221 - Minimally invasive treatment of acute Achilles tendon injuries with flexor hallucis longus tendon augmentation assisted by posterior ankle arthroscopy

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 51S
Author(s):  
Thiago Coelho Paim Lima ◽  
Rodrigo Gonçalves Pagnano ◽  
Gustavo Eiji Nodu Sato ◽  
Mauro Cesar Mattos e Dinato
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Achilles Tendon Rupture ◽  
Contralateral Side ◽  
Flexor Hallucis Longus ◽  
Posterior Ankle Arthroscopy ◽  
The Mean ◽  
Flexion Strength

Introduction: Achilles tendon ruptures cause significant functional limitations. The treatment for acute injury is controversial; conservative or surgical treatment and open or minimally invasive surgery are available options. The objective of this study is to evaluate the clinical and functional outcomes of patients with acute Achilles tendon rupture treated with minimally invasive tendon repair and augmentation with flexor hallucis longus tendon transfer assisted by posterior ankle arthroscopy. Methods: A retrospective, cross-sectional and observational study in which 5 patients with more than 24 months of postoperative follow-up were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, the Victorian Institute of Sport Assessment-Achilles (VISA-A), the Achilles Tendon Total Rupture Score (ATRS), the pain visual analog scale (VAS), and assessments of range of motion and strength. Results: The mean scores on the following instruments were obtained: pain VAS: 0.6; AOFAS: 98; VISA-A: 98.2 and ATRS: 100. The mean dorsiflexion range of motion was smaller (4.8º) than the contralateral range of motion (7.6º). The mean plantar flexion strength was 24.02 kgf on the operated side and 24.64 kgf on the contralateral side. The flexion strength of the hallux interphalangeal joint was weaker on the operated side (13.94 kgf) than on the contralateral side (17.6 kgf), albeit with no complaints from the patients. Conclusion: The proposed surgical treatment method had good clinical and functional outcomes among the patients evaluated in this study. The surgical technique presented herein may be a good alternative for the treatment of uncooperative patients diagnosed with acute Achilles tendon rupture due to tendinosis with important tendon degeneration.

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

Effects of 12-wk eccentric calf muscle training on muscle-tendon glucose uptake and SEMG in patients with chronic Achilles tendon pain

2014 ◽  
Vol 117 (2) ◽  
pp. 105-111 ◽  
Author(s):  
Tahir Masood ◽  
Kari Kalliokoski ◽  
S. Peter Magnusson ◽  
Jens Bojsen-Møller ◽  
Taija Finni
Keyword(s):  
Achilles Tendon ◽  
Glucose Uptake ◽  
Plantar Flexion ◽  
Achilles Tendinopathy ◽  
Triceps Surae ◽  
Medial Gastrocnemius ◽  
Flexor Hallucis Longus ◽  
Myoelectric Activity ◽  
Plantar Flexors ◽  
Lateral Gastrocnemius

High-load eccentric exercises have been a key component in the conservative management of chronic Achilles tendinopathy. This study investigated the effects of a 12-wk progressive, home-based eccentric rehabilitation program on ankle plantar flexors' glucose uptake (GU) and myoelectric activity and Achilles tendon GU. A longitudinal study design with control ( n = 10) and patient ( n = 10) groups was used. Surface electromyography (SEMG) from four ankle plantar flexors and GU from the same muscles and the Achilles tendon were measured during submaximal intermittent isometric plantar flexion task. The results indicated that the symptomatic leg was weaker ( P < 0.05) than the asymptomatic leg at baseline, but improved ( P < 0.001) with eccentric rehabilitation. Additionally, the rehabilitation resulted in greater GU in both soleus ( P < 0.01) and lateral gastrocnemius ( P < 0.001) in the symptomatic leg, while the asymptomatic leg displayed higher uptake for medial gastrocnemius and flexor hallucis longus ( P < 0.05). While both patient legs had higher tendon GU than the controls ( P < 0.05), there was no rehabilitation effect on the tendon GU. Concerning SEMG, at baseline, soleus showed more relative activity in the symptomatic leg compared with both the asymptomatic and control legs ( P < 0.05), probably reflecting an effort to compensate for the decreased force potential. The rehabilitation resulted in greater SEMG activity in the lateral gastrocnemius ( P < 0.01) of the symptomatic leg with no other within- or between-group differences. Eccentric rehabilitation was effective in decreasing subjective severity of Achilles tendinopathy. It also resulted in redistribution of relative electrical activity, but not metabolic activity, within the triceps surae muscle.

Endoscopic Flexor Hallucis Longus Transfer for Achilles Noninsertional Tendinopathy: Description of Surgical Technique and Functional Outcomes

2020 ◽  
pp. 193864001989591
Author(s):  
Juan Bernardo Gerstner G ◽  
Ian Winson ◽  
Jimmy Campo ◽  
Michael Swords ◽  
Juan Camilo Medina ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Case Series ◽  
Functional Results ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Flexor Hallucis Longus Transfer ◽  
The Mean ◽  
American Orthopaedic

Background. The transfer of the flexor hallucis longus (FHL) tendon is an established treatment for replacing a dysfunctional Achilles tendon. Objectives. (1) Describe a new technique for endoscopic FHL transfer for noninsertional Achilles tendinopathy and (2) describe the functional outcomes and complications after endoscopic and open FHL transfer. Materials and Method. Retrospective study of patients who underwent open or endoscopic FHL transfer between 2014 and 2016. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale was used preoperatively and postoperatively to measure the functional results. Results. We included 18 endoscopic FHL transfers and 24 open FHL transfers. The mean age of endoscopic and open procedures was 47.5 years (range 25-77 years) and 61.2 years (range 43-72 years), respectively. An improvement on the average AOFAS of 52.8% (31.9 points) was observed in the endoscopy group during the follow-up from the baseline. The mean improvement in AOFAS score for the open group was 41.4% (24.5 points). Four and 7 cases reported complications in the endoscopy and open FHL transfer groups, respectively. Conclusion. While both procedures were effective in treating noninsertional Achilles tendinopathy, the described arthroscopic treatment led to a greater improvement in the AOFAS score and is slightly less prone to lasting complications. Level of Evidence: Level IV: Case series

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

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