Reconstruction of Neglected Flexor Hallucis Longus Tendon Rupture: A Case Report

Isolated rupture of the flexor hallucis longus tendon is an unusual injury. We present the case of a neglected flexor hallucis longus tendon closed traumatic rupture at the plantar aspect of the first phalangeal head of the great toe in a middle-age male. The injury occurred while he was dancing. Because end-to-end tendon suture was impossible, the ensuing gap was repaired using a free plantaris tendon graft. We present the operative repair benefit of the flexor hallucis longus tendon rupture to regain the function and strength of the interphalangeal joint of the hallux, avoid extension of the distal phalanx, and maintain the longitudinal arch of the foot.     

Interference Screw Fixation for Flexor Hallucis Longus Tendon Transfer for Chronic Achilles Tendonopathy

Chronic Achilles tendinosis can be a challenging problem to the foot and ankle surgeon. Multiple surgical treatment options have been described for this condition including transfer of the Flexor Hallucis Longus (FHL) tendon for an incompetent Achilles tendon. Our technique describes FHL tendon transfer into the calcaneus to replace or supplement the Achilles tendon using a single posterior incision, a "short harvest" and interference screw fixation.     

Calcific Insertional Achilles Tendinopathy-Achilles Repair With Flexor Hallucis Longus Tendon Transfer: Case Series and Surgical Technique

Calcific insertional Achilles tendinopathy (CIAT) is a relatively common musculoskeletal entity that results in significant pain and disability, as well as posterior muscle group weakness. There is a lack of evidence criteria to support the timing of operative intervention, choice of procedures, or whether equinus requires treatment. The purpose of this study was to retrospectively review 45 patients (48 feet) who have undergone surgical management of CIAT with concomitant posterior muscle group weakness with the single heel rise testing. All patients underwent debridement and repair of the Achilles tendon with reattachment of the Achilles tendon to the calcaneus, ostectomy of the calcaneus, and flexor hallucis longus tendon transfer. Those patients with equinus also underwent gastrocnemius recession. The focus includes patient-reported satisfaction, time to return to normal shoe gear, and the incidence of revision surgery. The overall average of time to weightbearing was 4.3 weeks. After surgery, 73.3% (n?=?33) of the 45 patients responded to the following question: “Would you have this surgery done again?” Of these patients, 93.9% (n?=?31) responded “Yes” and 6.1% (n?=?2) responded “Unsure.” Of the same 33 patients, 84.8% (n?=?28) responded that they were “Very Satisfied” with the procedure and 15.2% (n?=?5) responded that they were “Satisfied.” Twelve patients (26.7%) did not respond to either question. One of the 12 patients (8.3%) who did not respond had bilateral procedures. None of the patients experienced tendon rupture, deep vein thrombosis, or the need for revision surgery. Four patients (8%) experienced a superficial infection, whereas 1 patient (2%) had development of a deep infection. No correlations were found when looking at the relationship between body mass index and return to weightbearing/normal shoe gear with Spearman analysis.     

Reconstruction of a Neglected Achilles Tendon Rupture With an Achilles Tendon Allograft: A Case Report

Multiple surgical techniques for repair of neglected Achilles tendon ruptures have been described in the literature. The authors present a case using a freeze-dried Achilles tendon allograft for repair of a neglected rupture of the Achilles tendon with a defect of 10 cm. At 1-year follow-up, the patient achieved pre-injury functional use of the affected limb.     

A Combined Surgical Approach for Extensor Hallucis Longus Reconstruction: Two Case Reports

The surgical management of foot tendon injuries is not well-represented in literature. To achieve excellent functional recovery of the extensor hallucis longus (EHL) tendon, we aimed at developing a reliable and feasible reconstructive technique.A surgical technique for delayed reconstruction of the EHL tendon, combining an elongation procedure with second toe extensor tendon transfer, is described in this article.The results of this combined approach for EHL tendon reconstruction were remarkable, since the patients of the two clinical cases reported regained active extension of the hallux after 6 months without any associated complication.This study represents a step forward in foot surgery, since it describes an alternative technique to manage EHL tendon lesions.     

A Combined Repair Technique for Early Neglected Achilles Tendon Ruptures

Abstract Objective: This study presents the long-term results of a combined technique, using both Duthie's biological repair and a plantaris tendon transfer for the reconstruction of early neglected tendo Achilles ruptures. Materials and Method: Between January 2000 and November 2004, nine patients with an early neglected Achilles tendon rupture (≥ 4 and ≤ 12 weeks from injury), underwent surgical reconstruction. Eight patients were male and one female, their age was average 41 years and the median follow-up period was 3.66 years. The average clinical defect of the Achilles tendon was 4.33 cm. Results: All patients were examined by the clinical ankle scoring system of Leppilahti et al. (Clin Orthop 346:152–161, 1998). Six patients presented excellent results and three patients had good results. All patients had equal plantarflexion and dorsiflexion with the healthy side and all of the study's patients returned to work 3 months postoperatively. An average muscle atrophy of 0.83 cm was documented compared with the uninjured side. Only four of nine patients (44.44%) had a normal one-legged jump. There were no complications postoperatively and no re-ruptures of the Achilles tendons. Conclusion: This combined method appears to be safe and effective, with a low risk for complications, allowing us to obtain excellent results for the majority of our patients.     

Split Peroneus Longus Free Tendon Autograft Transplantation for the Treatment of Neglected Extensor Hallucis Longus Tendon Laceration: A Case Report

A neglected laceration of the extensor hallucis longus (EHL) tendon is rare. Retraction of the tendon ends often occurs when a laceration is neglected, leading to a substantial tendon deficit. A paucity of case reports is available describing the treatment of EHL laceration with a large area of gap secondary to retraction. Therefore, the treatment recommendations are limited. We present the case of a neglected EHL tendon laceration with a 10.5-cm gap in a healthy 22-year-old female. The EHL tendon laceration was repaired using a split peroneus longus tendon autograft that, to the best of our knowledge, has not been previously reported. At the 3-year follow-up evaluation, the patient retained full function of her hallux and was free of symptoms.     

Achilles Tendon Lengthening for Equinus Foot with Miyoshi Myopathy: A Case Report

A 17-year-old male presented with reduced muscle strength in both lower limbs and demonstrated equinus foot (ankle equinus) in the right lower limb. Using dysferlin immunostaining, the patient was diagnosed with Miyoshi myopathy by the neurologist. Achilles tendon lengthening was performed, and a plantigrade foot without ankle equinus was achieved.     

Chronic Lateral Instability of the Ankle: Method of Reconstruction Using the Achilles Tendon

Reconstruction of the lateral ankle ligaments ad modum Storen, using the medial one third of the Achilles tendon as a nourished transplant is a relatively unknown procedure. Thirty patients operated on using this technique have been evaluated. the mean observation time was 4 years (range 1/2-16 years). All patients but one had a stable ankle joint and were satisfied. One was reoperated after sustaining a new injury 6 months after the original operation. the method described is a good alternative to other methods of ligamentous reconstruction. the procedure also stabilizes the subtalar joint and corrects recurrent subluxation of the peroneal tendons.     

Chronic Lateral Instability of the Ankle: Method of Reconstruction Using the Achilles Tendon

Reconstruction of the lateral ankle ligaments ad modum Storen, using the medial one third of the Achilles tendon as a nourished transplant is a relatively unknown procedure. Thirty patients operated on using this technique have been evaluated. the mean observation time was 4 years (range 1/2–16 years). All patients but one had a stable ankle joint and were satisfied. One was reoperated after sustaining a new injury 6 months after the original operation. the method described is a good alternative to other methods of ligamentous reconstruction. the procedure also stabilizes the subtalar joint and corrects recurrent subluxation of the peroneal tendons.     

Validity and Reliability of the Achilles Tendon Total Rupture Score

The best treatment of acute Achilles tendon rupture remains debated. Patient-reported outcome measures have become cornerstones in treatment evaluations. The Achilles tendon total rupture score (ATRS) has been developed for this purpose but requires additional validation. The purpose of the present study was to validate a Danish translation of the ATRS. The ATRS was translated into Danish according to internationally adopted standards. Of 142 patients, 90 with previous rupture of the Achilles tendon participated in the validity study and 52 in the reliability study. The ATRS showed moderately strong correlations with the physical subscores of the Medical Outcomes Study 36-item Short-Form Health Survey (r = .70 to .75; p < .0001) and Victorian Institute of Sports Assessment-Achilles questionnaire (r = .71; p < .0001). Test-retest of the ATRS showed no significant difference in the mean (2.41; p = .07). The limits of agreement were ±18.53. A strong correlation was found between test and retest (intercorrelation coefficient .908); the standard error of measurement was 6.7, and the minimal detectable change was 18.5. The Danish version of the ATRS showed moderately strong criterion validity. For study and follow-up purposes, the ATRS seems reliable for comparisons of groups of patients. Its usability is limited for repeated assessment of individual patients. The development of analysis guidelines would be desirable.     

Surgical Correction of Checkrein Deformity after Malunited Distal Tibia Fracture: A Case Report

Checkrein deformities are rare and involve entrapment or tethering of the flexor hallucis longus and, occasionally, flexor digitorum longus tendons. The deformity has typically been secondary to traumatic fractures of the talus, calcaneus, or deep posterior compartment syndrome resulting from fractures of the tibia and fibula and most fractures of the ankle. These result in flexion contractures at the interphalangeal joint of the hallux. Because of the rarity of this deformity, no single surgical technique has been defined as the standard. Previous interventions have included release of adhesions with or without Z-plasty lengthening of the involved tendons. The present study reports a case of checkrein deformity secondary to a malunited distal tibia fracture, with flexion deformities to digits 1 through 3. The patient underwent successful surgical correction with flexor tenotomies to the affected digits with interphalangeal arthrodesis to the hallux.     

An Innovative Anchoring Technique for Anterior Transfer of the Tibialis Posterior Tendon

Favorable results have been reported for tibialis posterior tendon transfers, which can effectively restore the dorsiflexion of the ankle and normal heel-to-toe gait. However, the commonly used methods for anchoring the transplanted tendon have some drawbacks. Therefore, we developed a new tendon-anchoring method to improve fixation of the transferred tendon and reduce the related complications. The new method entails tying the anchoring suture to the navicular bone instead of the button on the plantar foot to avoid wound complications. It requires no additional skin incisions or special equipment. We retrospectively evaluated 24 feet of 19 pediatric patients (13 [68.4%] females and 6 [31.6%] males) who had undergone anterior transfer of the tibialis posterior tendon with our new method from 2000 to 2013. All patients were clinically followed up. At the final follow-up visit, they were evaluated while standing and walking, and the range of motion of the foot was evaluated. The mean age at surgery was 7.8 (range 2 to 16) years. At the longest follow-up point, all the patients exhibited improved gait, except for 1 patient who required a secondary procedure. All the transferred tibialis posterior tendons could be palpated with certainty during active dorsiflexion or withdrawal of the foot. No tendon displacements, wound infections, or postoperative complications were observed. Fixation of a transferred tibialis posterior tendon by tying the suture to the navicular bone is simple and reliable. This technique can efficiently prevent the plantar ulcers that can develop with the traditional pull-out button method and provides a solution when appropriate-size bioabsorbable interference screws are unavailable.     

Subcutaneous Transposition of the Flexor Pollicis Longus: Does It Provide Increased Length for Tendon Repair? A Cadaveric Study

Background: Flexor pollicis longus (FPL) tendon lacerations typically occur via sharp mechanisms such as knife injury. When the injury is chronic, it may be difficult to perform a tension free repair, and tendon lengthening may be required. This article proposes a technique that transposes the proximal tendon stump over the thenar eminence subcutaneously, out of the carpal tunnel, in an attempt to gain additional tendon length by eliminating the sharp turn the FPL takes. Methods: A total of 17 cadaveric hands were used. The FPL tendon was identified and affixed to soft tissue in the distal forearm as well as at the thumb metacarpophalangeal (MP) joint with hypodermic needles. The tendon was then transected at the level of the MP joint of the thumb, removed from the carpal tunnel, and transposed on top of the thenar eminence to reach where it had been transected. The length gained by transposing the tendon was recorded by measuring the overlap of the tendon ends at the MP joint. Results: The mean amount lengthened was 7.6 mm with a standard deviation of 2.4 mm, ranging from as little as 5 mm to as high as 13 mm. Conclusions: To our knowledge, transposition of FPL tendon is a novel technique that has not been reported. Based on our cadaveric study, it can be used to bridge gaps between approximately 5 mm and 10 mm. Clinically, this amount of gap could potentially be more easily managed by simply making the repair tighter than usual as opposed to transposing the tendon.     

Gravity Equinus Position to Control the Tendon Length of Reversed Free Tendon Flap Reconstruction for Chronic Achilles Tendon Rupture

Repair of chronic Achilles tendon rupture is a surgical challenge. We describe the use of a free turndown tendon flap augmentation raised from the proximal gastrocnemius aponeurosis. To control optimal tension or the reconstructed Achilles tendon length, we used an original method by referring to the gravity planter flexion ankle angle of the contralateral limb. Key aspects of the technique are described. A retrospective analysis of the short-term outcomes achieved in a case series (n = 56) is presented. The postoperative anthropometric findings are also presented to indicate the successful outcomes achieved with this technique.