Combined flexor hallucis longus tendon transfer and gastrocnemius recession for reconstruction of gapped chronic achilles tendon ruptures |
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| Affiliation: | 1. Assisstant Prof of Orthopedic Surgery, Kafr Elsheikh University, Egypt;2. Assisstant Prof of Orthopedic Surgery, Mansoura University, Egypt;1. Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea;2. Department of Mathematics, College of Natural Science, Ajou University, Gyeonggi, South Korea;1. Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK;2. Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, UK;1. St. Alphonsus Regional Medical Center, 901 N. Curtis Rd., Ste 501, Boise, ID 83706, United States;2. OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN, United States;1. Department of Surgery, Nassau University Medical Center, East Meadow, NY 11554, USA;2. Division of Trauma, Kings County Hospital Medical Center, Brooklyn, NY 11203, USA;3. Department of Family Medicine, Nassau University Medical Center, East Meadow, NY 11554, USA;4. Department of Epidemiology & Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA;1. Division of Emergency Medicine, Weill Cornell Medical College, New York, NY, United States;2. University of Colorado Medical School, Aurora, CO, United States;3. Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, NY, United States;4. National Center for Injury Prevention and Control, Centers for Disease Control, Atlanta, GA, United States;5. Department of Surgery, Weill Cornell Medical College, New York, NY, United States;1. Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland;2. Center for Surgery of the Foot & Ankle, Clinique La Colline, Geneva, Switzerland;3. Division of Anatomy, University of Geneva Medical Center, Geneva, Switzerland;4. Faculté de Médecine, University of Geneva Medical Center, Geneva, Switzerland |
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| Abstract: | ObjectiveThe aim of this study was to assess the functional outcomes after a combined FHL transfer and a gastrocnemius recession for treatment of chronic ruptures of Achilles tendon with a gap and to investigate the patient's satisfaction about the great toe function after transfer.Material and methods19 patients with chronic rupture of the Achilles tendon with a gap were treated with a flexor halluces longus tendon transfer combined with a gastrocnemius recession, Clinical diagnosis depends on the presence of gap in the tendon on examination, inability of tip toe walking on the affected side and positive calf-squeeze test, MRI was used to confirm the clinical diagnosis. American Orthopedic Foot & Ankle Society hind foot score was used for assessment of the results.ResultsThe AOFAS score improved significantly from a mean of 65 preoperatively to 94 at the last follow up (p < 0.001), there was no significant difference in the final outcome between patients with FHL tendon weaved through the stump of the Achilles tendon and those with trans osseous tunnels, the mean AOFAS score at the last follow up was 94.2, 93.8 respectively, no patient complained of big toe dysfunction.ConclusionManagement of chronic rupture of the Achilles tendon with a gap with flexor halluces longus tendon transfer combined with a gastrocnemius recession is a safe and reliable method with a significantly improved functional outcome, muscle advancement through gastrocnemius recession decreases the length of the gap without affecting the muscle function, flexor halluces longus tendon transfer doesn't harm the big toe function. |
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| Keywords: | Achilles tendon Flexor halluces longus Gastrocnemius recession Transosseous tunnel |
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