Comparison of results of open and endoscopic flexor hallucis tendon longus (FHL) transfer for management of chronic Achilles’ tendon rupture

P. Garg, P. Ray

Introduction: FHL transfer is a well-known technique of managing chronic Achilles’ tendon ruptures. Traditionally it was done as an open procedure in conjunction with a repair of the Achilles tendon. Recently there have been several publications describing endoscopic FHL transfer and publishing good, comparable outcomes with this technique. But there are no published studies comparing open and endoscopic results. We believe that a comparative study can provide a good insight into the advantages and disadvantages of this procedure and provide clinicians good evidence and guidance.
 

Materials and methods:  Fourteen patients were treated endoscopically while 26 with an open technique. Of the 26, fourteen had an open Achilles tendon repair and FHL transfer while 12 has only open FHL transfer. All the endoscopic patients had only an FHL transfer. We compared the demographics, pre op gap documented by ultrasound, complications of the procedure, recovery times, return to work and strength after 1 year and ATRS. We also conducted an MRI scan of three patients each of the three groups to determine the state of Achilles tendon and FHL tendon after 1 year of surgery.
 

Results: Demographic data and pre op characteristics of the only endoscopic groups, both open and endoscopic were comparable. There were similar complication rates for both only FHL groups but the open FHL + Achilles’ repair had more complications (wound, neuropraxia). Return to work and ATRS at 6 weeks was better for the endoscopic group than the other groups. The strength and ATRS at 6 months and 1 year were similar for all three groups.
 

Conclusion: Endoscopic FHL transfer is a safe and effective method of managing chronic Achilles’ tendon rupture providing an earlier return to work and 6 weeks patient satisfaction , less complications and similar strength as the other techniques.