Flexor hallucis longus transfer clinical outcome through a single incision for chronic Achilles tendon rupture

Abubeih, Hossam; Khaled, Mohamed; Saleh, Waleed Riad; Said, Galal Z.

doi:10.1007/s00264-018-3976-x

Cited by 19 publications

(16 citation statements)

References 23 publications

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“…Surgical procedures, mostly consisting of debridement with direct repair, are considered when conservative treatment is not successful after an average period of 3-6 months [7,8]. A variety of surgical options have been described without a definitive consensus on the best technique [9].…”

Section: Introductionmentioning

confidence: 99%

Flexor hallucis longus hypertrophy secondary to Achilles tendon tendinopathy: an MRI-based case–control study

Wirth

Andronic

Aregger

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose The purpose of this study was to outline an indirect sign of advanced Achilles tendinopathy on magnetic resonance imaging (MRI), based on the hypothesis that these patients would present with secondary hypertrophy of the flexor hallucis longus muscle (FHL). Methods MRI scans of Achilles tendon were analyzed retrospectively in two cohorts. The study group consisted of consecutive patients presenting with clinical signs of Achilles tendinopathy and no previous surgeries, while the control group were patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4–5 cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the FHL muscle. Ratios (FHL/TS) were calculated for area (Ar) and diameter (Dm) measurements. Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both ratios to assess potential cutoff points to differentiate between the groups. Results A total of 60 patients for each study group were included. Both ratios Ar(FHL/TS) and Dm(FHL/TS) showed significant higher values in the tendinopathy group (p < 0.001). There were strong to very strong intraclass correlation coefficients (ICC = 0.75–0.93). A diameter ratio Dm (FHL/TS) of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy. Conclusion In our patient cohort, FHL hypertrophy was observed in patients with Achilles tendinopathy as a possible compensatory mechanism. Measuring a diameter ratio Dm(FHL/TS) of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.

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Section: Introductionmentioning

confidence: 99%

Flexor hallucis longus hypertrophy secondary to Achilles tendon tendinopathy: an MRI-based case–control study

Wirth

Andronic

Aregger

et al. 2021

Eur J Orthop Surg Traumatol

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“…To date, there is no gold standard method for chronic AT ruptures. Although there are some studies on the application of flexor hallucis longus tendon (FHLT) transfer in the reconstruction of AT for large defects [9][10][11][12]. Whether FHLT transfer is superior to other autologous tendons or allogeneic tendons remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Flexor hallucis longus tendon transfer through a single incision in the treatment of chronic Achilles tendon rupture with large defect

Xu¹,

Li²,

Xiang³

et al. 2020

Preprint

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Background To evaluate the medium-to-long term clinical outcome of flexor hallucis longus tendon transfer through a single incision in the treatment of chronic Achilles tendon rupture with a defect greater than 5 cm. Methods Clinical data of patients treated with flexor hallucis longus tendon transfer due to chronic Achilles tendon rupture between January 2009 and December 2016 were reviewed retrospectively. All cases were presented with Achilles tendon rupture for more than 4 weeks after injury. The defect of the Achilles tendon was greater than 5 cm after debridement in all patients. Clinical outcomes were assessed with AOFAS Ankle-Hindfoot Scale (AOFAS-AH), Achilles tendon Total Rupture Score (ATRS) and AOFAS Hallux Metatarsophalangeal-lnterphalangeal Scale (AOFAS-HM). Results 18 patients were followed successfully for 24-83 months (mean follow-up time of 43.2 months) and 5 were lost. According to the complete datasets obtained from 18 patients, none of the tendons re-ruptured during the follow-up. The AOFAS-AH and ATRS at last follow-up visit was 94.4 ± 3.2 (87-100) and 89.6 ± 5.9 (72-98) respectively, which revealed statistically significant improvement from the preoperative score of 58.2 ± 6.3 (49-70) and 53.3 ± 7.3(42-68). The AOFAS-HM at last follow-up visit was 90.1 ± 5.2 (77-97). Conclusion The flexor hallucis longus tendon transfer through a single incision is a safe and simple method for chronic Achilles tendon rupture with minimal morbidity and complications.

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“…(7,8) A variety of surgical options have been described without a de nitive consensus on the best technique. (9) If there is advanced damage of the tendon(6), a tendon transfer is a recommended option. (10)(11)(12)(13) One of the most widely used is the exor hallucis longus (FHL) transfer.…”

Section: Introductionmentioning

confidence: 99%

Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study

Wirth

Andronic

Aregger

et al. 2020

Preprint

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Background: The purpose of this study was to outline indirect signs of advanced Achilles tendinopathy on magnetic resonance imaging (MRI) and develop a potential tool that could aid in surgical decision-making.Methods: Magnetic resonance imaging (MRI) scans of Achilles tendon were analyzed retrospectively in two consecutive cohorts. Control group consisted of patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4 to 5 cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the flexor hallucis longus (FHL). Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both quotients to assess potential cut-off points.Results: A total of 60 patients for each study group were included. The ratios for area and for diameter showed significant higher values for FHL in the tendinopathy group (p<0.001). There was strong to very strong interobserver agreement (rho=0.744). A diameter ratio FHL/TS of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy.Conclusion: In our patient cohort, flexor hallucis longus hypertrophy was observed even before a tendon transfer was employed as a possible compensatory mechanism for Achilles tendon tendinopathy. Using the tool described in this study, measuring a value of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.

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Flexor hallucis longus transfer clinical outcome through a single incision for chronic Achilles tendon rupture

Abstract: Single-incision flexor hallucis longus transfer for chronic Achilles tendon ruptures is a simple method with minimal morbidity and complications. The technique resulted in great patients' satisfaction as well as excellent functional and clinical outcomes.

Cited by 19 publications

References 23 publications

Flexor hallucis longus hypertrophy secondary to Achilles tendon tendinopathy: an MRI-based case–control study

Flexor hallucis longus hypertrophy secondary to Achilles tendon tendinopathy: an MRI-based case–control study

Flexor hallucis longus tendon transfer through a single incision in the treatment of chronic Achilles tendon rupture with large defect

Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study

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