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Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer
Julien Wegrzyn1, Jean-François Luciani, Rémi Philippot
1Department of Orthopedic Surgery and Sports Medicine, Centre Hospitalier Lyon-Sud, Pierre Bénite, France. julien.wegrzyn@chu-lyon.fr
This study shows that modified flexor hallucis longus (FHL) transfer surgery effectively treats chronic Achilles tendon (AT) ruptures, achieving excellent functional outcomes and minimal complications. The procedure improved patient scores significantly, even with persistent strength deficits.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Reconstructive Surgery
Background:
- Chronic Achilles tendon (AT) ruptures present significant management challenges.
- Previous treatments for large AT defects have variable outcomes.
- Flexor hallucis longus (FHL) tendon transfer is a reconstructive option.
Purpose of the Study:
- To evaluate the management and outcomes of chronic Achilles tendon ruptures treated with a modified FHL transfer.
- To assess functional recovery and complications in patients undergoing this procedure.
Main Methods:
- Retrospective review of 11 patients with chronic AT ruptures treated with modified FHL transfer and AT stump augmentation.
- Functional assessment using the American Orthopaedic Foot and Ankle Society (AOFAS) score.
- Isokinetic evaluation of ankle plantarflexion strength.
Main Results:
- Excellent functional outcomes reported, with significant AOFAS score improvement at an average 79-month follow-up.
- No re-ruptures or major complications, including wound healing issues.
- Patients experienced a loss of hallux interphalangeal joint motion, but without functional impact.
- Isokinetic testing showed persistent plantarflexion torque deficits (28-36%).
Conclusions:
- Modified FHL transfer with AT stump reinforcement is a safe and effective surgical option for chronic Achilles tendon ruptures with large defects (>5 cm).
- The procedure leads to excellent functional recovery despite persistent strength deficits.
- FHL tendon harvesting did not cause significant morbidity.
