The functional and dynamometer-tested results of transtendinous flexor hallucis longus transfer for neglected ruptures of the Achilles tendon at six years’ follow-up

Lever, Caroline J.; Bosman, Hilary A.; Robinson, A. H. N.

doi:10.1302/0301-620x.100b5.bjj-2017-1053.r1

Cited by 24 publications

(27 citation statements)

References 32 publications

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“…5,37 However, it has frequently been adapted as a research tool in injuries of other joints, including injuries of the Achilles tendon. 9,16,21,24,25,28,[33][34][35] Although the validity of the Tegner scale for use in patients with Achilles injuries rather than ligamentous knee injuries is less clearly defined, the tool has precedent in the literature and was the best tool available commonly used for quantifying sport and activity levels in lower extremity sports injuries. The study's retrospective design required patient recall of their preinjury Tegner activity level.…”

Section: Discussionmentioning

confidence: 99%

Association of Strength Following Achilles Tendon Repair With Return to Same Level of Play in High-Level Athletes

et al. 2020

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Background: Rupture of the Achilles tendon is a common injury and the ability to return to the same level of sporting activity after treatment is an important outcome for patients. The objective of the current study was to examine the relationship between ankle strength and the ability to return to previous level of play following operative repair of an Achilles tendon rupture. Methods: Patients aged 18 to 50 years at a minimum 1 year postoperation from surgical repair of an Achilles tendon returned for a study visit. Patients reported both preinjury and current activity level using the 10-point Tegner Activity Level Scale. Isokinetic strength testing was performed and the Isokinetic Strength Score (ISS) was calculated. Logistic regression analysis was used to determine the relationship between ISS and return to play by Tegner level. A total of 36 patients (mean 35 years old, 72% male) completed the study protocol at a mean 1.8 years postoperatively. Results: Logistic regression revealed no association between ISS and return to play in the complete cohort. Subgroup analysis revealed that for 20 high-level athletes (preinjury Tegner ≥ 7), for every 16-point increase in ISS, the odds ratio (OR) for return to same level of play was 8.3 ( P = .055) and the OR for return to within 1 Tegner level of play was 6.3 ( P = .043). There was no association between ISS and return to previous activity in the 16 patients with lower preinjury levels of activity. Conclusion: Improved ankle strength was associated with return to previous level of activity in patients participating in high-level athletic activity, suggesting that these patients were more dependent on recovery of ankle strength in the postoperative time period in order to return to their previous high level of play. In contrast, regaining strength may be less important for returning to normal activities for less active patients. Level of Evidence: Level III, comparative series.

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Section: Discussionmentioning

confidence: 99%

Association of Strength Following Achilles Tendon Repair With Return to Same Level of Play in High-Level Athletes

et al. 2020

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“…Reconstruction of AT with FHLT transfer could reduce the plantar flexion strength of the hallux, resulting in reduced balance or strength of propulsion theoretically [26,32]. Richardson et al reported decreased distal phalangeal pressure and FHL weakness in 22 patients, but no difference was found in plantar pressure of the first or second metatarsal head [29].…”

Section: Discussionmentioning

confidence: 99%

“…The tenodesis of FHLT to FDLT resulting in floating halluces with hyperextension and alignment problems were reported in some studies [26,27]. Some authors do not routinely perform a tenodesis of FHLT to FDLT, they also noticed the weaker hallux postoperatively, but it was not a clinical issue for most patients [32]. However, it is uncertain whether this technique is suitable for athletes and sports participants who have a high need for movement.…”

Section: Discussionmentioning

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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“…The FHL tendon can be obtained by minimally invasive endoscopic surgery 16 and can provide good function. 8,15 However, FHL transfer has been associated with increased risk of vascular nerve injury, 20 decreased hallux function, 3 decreased strength of the FHL tendon, and a decline in toe grip strength. 6 Thus, we did not choose FHL transfer as our goal of comparison.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Gastrocnemius Turn Flap and Hamstring Graft for the Treatment of Kuwada Type 3 Chronic Ruptures of the Achilles Tendon: A Retrospective Study

Bai

Guan

You

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:Chronic Achilles tendon rupture is challenging to repair, and many procedures have been suggested to fill the gap that separates the distal and proximal ends of the ruptured tendon.Purpose:To compare clinical outcomes between the free hamstring graft (HG) and gastrocnemius turn flap (GTF) procedures in the treatment of chronic Achilles tendon rupture.Study Design:Cohort study; Level of evidence, 3.Methods:This retrospective study included 26 patients (25 males, 1 female; mean age, 36.7 years; range, 22-53 years) with Kuwada type 3 chronic rupture of the Achilles tendon. A total of 11 patients underwent GTF surgery, whereas 15 patients underwent HG surgery. Follow-up assessments were conducted at 3, 6, and 12 months postoperatively.Results:The complication rate was significantly higher in the GTF group compared with the HG group (27.2% vs 6.6%, respectively; χ2 = 12.462; P = .001). At the 3-month follow-up, the degree of ankle dorsiflexion was significantly higher in the HG group than in the GTF group (t = 3.144; P = .004). At 6-month and 1-year follow-up, no significant differences in ankle function were seen between the 2 groups.Conclusion:Hamstring tendon graft is associated with better early recovery of dorsiflexion compared with GTF. The long-term clinical outcomes of these 2 procedures are similar.

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The functional and dynamometer-tested results of transtendinous flexor hallucis longus transfer for neglected ruptures of the Achilles tendon at six years’ follow-up

Cited by 24 publications

References 32 publications

Association of Strength Following Achilles Tendon Repair With Return to Same Level of Play in High-Level Athletes

Association of Strength Following Achilles Tendon Repair With Return to Same Level of Play in High-Level Athletes

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

Comparison of Gastrocnemius Turn Flap and Hamstring Graft for the Treatment of Kuwada Type 3 Chronic Ruptures of the Achilles Tendon: A Retrospective Study

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