Flexor hallucis longus transfer versus turndown flaps augmented with flexor hallucis longus transfer in the repair of chronic Achilles tendon rupture

Background

Repairs of chronic Achilles tendon ruptures are technically challenging due to large defects after scar excision. Multiple techniques for repair have been proposed but little consensus on best practice established. This study aims to compare flexor hallucis longus (FHL) transfers versus turndown flaps augmented by FHL transfers.

Methods

Between 2005 and 2015, 49 unilateral repairs of chronic Achilles tendon ruptures were performed. We retrospectively compared the outcomes of 20 patients who underwent FHL transfer with 19 patients who underwent turndown flaps augmented with FHL transfer before surgery and at three time points after surgery (three, six and twelve months). Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and the 36-Item Short Form Health Survey (SF-36) were used to evaluate outcome.

Results

Both techniques demonstrated significant improvement in their outcome scores and were comparable to one another. At one year, the mean VAS score was 0 for both groups. The mean AOFAS Ankle-Hindfoot score was 90 ± 11 (FHL) and 95 ± 10 (FHL with turndown flaps); and SF-36 scores showed significant improvements in physical, role and social function scores. Turndown flaps augmented with FHL transfer however required significantly longer operative time (100 ± 21 min) compared to FHL transfer alone (73 ± 23 min).

Conclusions

FHL transfer required significantly less operative time compared to turndown flaps augmented with FHL transfer, with comparable outcomes. FHL transfer is a reliable and effective technique in the repair of chronic Achilles tendon ruptures.