Achilles tendon injuries most commonly occur in athletes, but also in the middle-aged population practicing recreational sports. The aetiology of injury and disease of the Achilles tendon has not been completely clarified. While acute injury can be attributed to trauma, research showed that a chronic degenerative process is present in most ruptures. While there are still a lot of dilemmas when it comes to treating acute rupture, chronic rupture and disease are predominantly treated operatively. Many operative procedures can be used when treating chronic Achilles tendon diseases, such as excision of degenerative changes and tendon decompression, reconstruction using fascia lata and VY plastics, tendon transfer (Flexor Hallucis Longus - FHL, Flexor Digitorum Longus - FDL, Peroneus Brevis - PB) and allograft and synthetic graft reconstruction. The objective of the paper was to present the results of treating chronic partial Achilles tendon rupture by scar excision and FHL tendon transposition. The patients were one professional and one recreational athlete, both of whom were treated nonoperatively for a long time. They were both tested using AOFAS and ATRS tests preoperatively and postoperatively. The results showed a significant improvement of function and both patients were able to return to their usual activities. Postoperative results of AOFAS and ATRS tests were almost identical to the result on the uninjured leg. Our little series, as well as a lot of research performed by other authors, shows that an FHL tendon transposition is a safe and efficient method in treating diseases and injuries of the Achilles tendon.
References
1.
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical Rating Systems for the Ankle-Hindfoot, Midfoot, Hallux, and Lesser Toes. Foot & Ankle International. 1994;15(7):349–53.
2.
Hahn F, Maiwald C, Horstmann T, Vienne P. Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus transfer. Clin Biomech. 2008;23(1):109–16.
3.
Yeoman TFM, Brown MJC, Pillai A. Early post-operative results of neglected tendo-Achilles rupture reconstruction using short flexor hallucis longus tendon transfer: A prospective review. The Foot. 2012;22(3):219–23.
4.
Wegrzyn J, Luciani JF, Philippot R, Brunet-Guedj E, Moyen B, Besse JL. Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. International Orthopaedics. 2010;34(8):1187–92.
5.
El-Tantawy A, Azzam W. Flexor hallucis longus tendon transfer in the reconstruction of extensive insertional Achilles tendinopathy in elderly: an improved technique. European Journal of Orthopaedic Surgery & Traumatology. 2015;25(3):583–90.
6.
Silver R, de la Garza J, Rang M. The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. The Journal of Bone and Joint Surgery British volume. 1985;67-B(3):432–7.
7.
Hansen ST. Trauma to the heel cord. Jahss MH,ed Disorders of the foot and ankle. 1991;2357.
8.
Zantop T, Tillmann B, Petersen W. Quantitative assessment of blood vessels of the human Achilles tendon: an immunohistochemical cadaver study. Archives of Orthopaedic and Trauma Surgery. 2003;123(9):501–4.
9.
Åstroöm M, Westlin N. Blood flow in the human achilles tendon assessed by laser doppler flowmetry. Journal of Orthopaedic Research. 1994;12(2):246–52.
10.
Perry JR. ACHILLES TENDON ANATOMY. Foot and Ankle Clinics. 1997;2(3):363–70.
11.
MAFFULLI N. Current Concepts Review - Rupture of the Achilles Tendon*. The Journal of Bone & Joint Surgery. 1999;81(7):1019–36.
12.
Ahemad M. A. A, Abdul NM, Syed MA. Chronic insertional achilles tendon ruptures treated by suture anchor repair and augmentation with flexor hallucis longus tendon transfer. International Journal of Research in Orthopaedics. 4(2):227.
13.
Abraham E, Pankovich A. Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap. The Journal of Bone & Joint Surgery. 1975;57(2):253–5.
14.
Farizon F, Pages A, Azoulai JJ, Lavison R, Bousquet G. Surgical treatment of ruptures of the Achilles tendon. a propos of 42 cases treated by Bosworth’s technique. Rev Chir Orthop Reparatrice de l’Appareil Moteur. 1997;83(1):65–9.
15.
Astrom M. On the nature and etiology of chronic Achilles tendinopathy. 1997.
16.
Williams JGP. Achilles Tendon Lesions in Sport. Sports Medicine. 1986;3(2):114–35.
17.
Carlstedt CA. Mechanical and chemical factors in tendon healing. Acta Orthopaedica Scandinavica. 1987;58(sup224):1–75.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
