Paper # 215: Muscle Architectural and Functional Differences Between Traditional vs. Early Active Rehabilitation Programs After Achilles Tendon Repair

Vaz, Marco Aurélio; Ott, Rafael Duvelius; Geremia, Jeam Marcel; Nova, Mayra Casa; Silva, Valdirene Gambarra Da; Frasson, Viviane Bortoluzzi

doi:10.1016/j.arthro.2011.08.215

Cited by 1 publication

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9 This altered production of collagen may result in the tendon being less resistant to tensile forces and, thus, at increased risk of rupture. 10 As for the FHL harvest, transfer morbidity is clinically insignificant, even for good push-off or balance in running sports. 11 Our minimally invasive technique for achieving FHL transfer further eliminates morbidity from this procedure, such as wound healingerelated problems (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Salvage Flexor Hallucis Longus Transfer for a Failed Achilles Repair: Endoscopic Technique

Gonçalves

Caetano

Côrte-Real

2015

Arthroscopy Techniques

View full text Add to dashboard Cite

Flexor hallucis longus (FHL) transfer is a well-established treatment option in failed Achilles tendon (AT) repair and has been routinely performed as an open procedure. We detail the surgical steps needed to perform an arthroscopic transfer of the FHL for a chronic AT rupture. The FHL tendon is harvested as it enters in its tunnel beneath the sustentaculum tali; a tunnel is then drilled in the calcaneus as near to the AT footprint as possible. By use of a suture-passing device, the free end of the FHL is advanced to the plantar aspect of the foot. After adequate tension is applied to the construct, the tendon is fixed in place with an interference screw in an inside-out fashion. This minimally invasive approach is a safe and valid alternative to classic open procedures with the obvious advantages of preserving the soft-tissue envelope and using a biologically intact tendon.T he incidence rates of Achilles tendon (AT) rerupture after primary surgical repair vary widely in the literature.1,2 Several treatment options exist, such as V-Y advancement and the Bosworth turn-down repair.3 Other surgical techniques use tendon transfers of the peroneus brevis, flexor digitorum longus, and flexor hallucis longus (FHL). The use of an FHL transfer has been proposed 4,5 because it is a stronger plantar flexor, its axis of contractile force more closely reproduces that of the AT, it fires in phase with the gastrocnemius-soleus complex, and its anatomic proximity avoids iatrogenic lesions of the neurovascular bundle. Another benefit of FHL transfer is plantar flexion strength reinforcement, which is almost always compromised with fascial advancement alone. 6Regarding vascularization of the AT, the FHL muscle belly extends distally into the avascular zone of the AT and allows recruitment of an increased blood supply to the repaired AT. Furthermore, FHL transfer maintains the normal muscle balance of the ankle by transferring a muscle with the same function. In a recent study using magnetic resonance imaging evaluation, Hahn et al. 4 showed complete integration of the FHL tendon in 60% of patients and hypertrophy of the FHL of more than 15% was observed in 80% of patients. Case DescriptionWe present the case of a 34-year-old man with no known pathology and an irrelevant medical history and habits. He was a recreational sports participant and sustained an AT rupture. Primary surgery was performed 2 weeks after the initial trauma by a minimally invasive technique (Achillon System; Integra LifeSciences, Plainsboro, NJ). The patient began physical therapy after 3 weeks of equinus cast immobilization and had good progression until 12 weeks postoperatively, when a rerupture occurred while he was working out on a treadmill. The patient then underwent reoperation with the technique described in this report. Surgical TechniquePosterior ankle endoscopy is performed in a standard fashion. 7 The patient lies prone, and a 2-portal technique using the posterolateral and posteromedial portals is performed (Fig 1). The posterolateral ...

show abstract

Section: Discussionmentioning

confidence: 99%