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. 2017 Sep 18;7(2):341-346.
doi: 10.11138/mltj/2017.7.2.341. eCollection 2017 Apr-Jun.

Endoscopic Flexor Halluces Longus transfer for Chronic Achilles Tendon rupture - technique description and early post-operative results

Daniel Baumfeld  1 , Tiago Baumfeld  1 , André Rocha Figueiredo  2 , Luis Fernando de Araujo Junior  3 , Benjamim Macedo  4 , Thiago Alexandre Alves Silva  2 , Fernando Raduan  5 , Caio Nery  5
Affiliations

Endoscopic Flexor Halluces Longus transfer for Chronic Achilles Tendon rupture - technique description and early post-operative results

Daniel Baumfeld et al. Muscles Ligaments Tendons J. .

Abstract

Background: Achilles tendon ruptures may lead to proximal retraction of the stump if not treated acutely, increasing the chances of poorer functional outcomes. The flexor halluces longus transfer is a well-established treatment option, usually performed as an open procedure. The aim of this paper is to report the preliminary results and describe the technique of endoscopic flexor halluces longus transfer.

Material and methods: Six patients with chronic Achilles tendon injuries or re-ruptures were treated with endoscopic FHL transfer. The Achilles Tendon Rupture Score was used to clinically evaluate the patients. Single leg heel rise ability, functional hallux weakness, complications and procedure length were also checked.

Results: On average, we took 56 minutes to perform the surgery. All patients had a major increase in the ATRS score value postoperatively. Single leg heel rise was possible for all patients without limitation. None of the patients noticed functional weakness of the hallux during daily life activity and no wound or soft tissue complications were seen.

Conclusion: Endoscopic FLH transfer is a reliable option for patients with high 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.

Level of evidence: 4.

Keywords: Achilles tendon re-rupture; Achilles tendon rupture; endoscopy; flexor halluces longus transfer; minimally invasive surgery.

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Conflict of interest statement

Conflict of Interest Caio Nery has received Consultor and Speaker honorarium from Arthrex. All the other Authors declare they have no conflict of interest.

Figures

Figure 1
Figure 1
Posterolateral and posteromedial portals for posterior ankle endoscopy
Figure 2
Figure 2
FHL identification.
Figure 3
Figure 3
a. Ankle and hallux positioned in maximal plantar flexion, seeking the maximum tendon length; b. FHL proximal traction.
Figure 4
Figure 4
Tendon stump externalized through de posteromedial portal.
Figure 5
Figure 5
Calcaneal tunnel performed under endoscopy and radioscopic visualization through the posterolateral portal.
Figure 6
Figure 6
A. Introduction of the interference screw; B. Endoscopic view of the tunnel after fixation.
See this image and copyright information in PMC

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