Abstract
Introduction
Flexor Hallucis Longus (FHL) tendon transfer is a well-recognised salvage operation for irreparable tendon Achilles (TA) ruptures and intractable Achilles tenonopathy. Several case series describes the technique and results of arthroscopic FHL tendon transfers. We present a comparative case series of open and arthroscopic FHL tendon transfers from Southmead Hospital, Bristol, UK.
Methods
For the arthroscopic FHL transfers in most cases the patients were positioned semi prone with a tourniquet. A 2 or 3 posterior portal technique was used and the tendon was secured using an RCI screw. The rehabilitation was similar in both groups with 2 weeks in an equinus backslab followed by gradual dorsiflexion in a boot over the following 6 weeks. Anticoagulation with oral aspirin for 6 weeks was used. A retrospective case note review was performed.
Results
There were 12 arthroscopic (8 males, 4 female) and 16 open procedures (9 male, 7 female). Both had a mean age of 56. 1 arthroscopic FHL was lost to follow up. There were no concomitant procedures in the arthroscopic group. In the open group the TA was repaired in 7 cases (3 of these involved z-shortening). There was 1 plantaris interposition, 1 V-Y advancement and 1 gastrocnemius advancement. Degenerate tendon was excised in 1 severe re-rupture of a calcified tendinopathic achilles. There was no difference in tourniquet time between the groups (arthroscopic 69mins vs open 64 mins, p=0.64). There were no complications in the arthroscopic group. In the open group there was 1 superficial wound infection, 1 nerve injury & 1 delayed DVT at 3 months.
Conclusion
Arthroscopic FHL transfer is a safe and effective surgical option when no other achilles procedures are required. The soft tissue insult is minimal, making it a good option for patients with poor soft tissues or neurovascular compromise.
