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Transosseous Flexor Hallucis Longus Tendon Transfer for Large Achilles Tendon Defects: Surgery Technique and Outcome
Philipp Friederichsen1, Simone Zwicky1, Anika Stephan2
1Department of Foot Surgery, Schulthess Klinik, Zurich, Switzerland.
Foot & Ankle International
|January 11, 2025
Summary
Transosseous flexor hallucis longus (FHL) tendon transfer effectively treats large Achilles tendon defects, significantly improving function and reducing pain. Big toe flexion weakness is not a clinically relevant issue, making it a successful surgical option.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Reconstructive Surgery
Background:
- Chronic Achilles tendinopathy with large defects presents surgical challenges.
- Concerns exist regarding flexor hallucis longus (FHL) tendon transfer due to potential shortened lever arm and big toe weakness.
Purpose of the Study:
- To evaluate the 2-year outcomes of transosseous FHL tendon transfer for treating large Achilles tendon defects.
Main Methods:
- Retrospective analysis of 28 patients undergoing FHL transfer for Achilles defects.
- Defect extent measured by MRI; outcomes assessed using German Foot Function Index (FFI-D), UCLA activity scale, patient satisfaction, and complications.
Main Results:
- Significant improvement in mean FFI-D pain and disability scores at 24 months (37.2 to 6.9 and 52.3 to 15.0, respectively).
- 82% of patients reported satisfaction (57% very satisfied, 25% satisfied) at 2-year follow-up.
- One patient experienced mild, non-limiting big toe flexion weakness; 3 patients had minor postoperative complications that resolved.
Conclusions:
- Transosseous FHL transfer is a successful treatment for large Achilles tendon defects, yielding significant functional and pain improvements.
- Patient satisfaction is high, and concerns about clinically relevant big toe flexion weakness are largely unfounded.
