Flexor hallucis longus reroute for chronic achilles tendon rupture with no root

Background
Chronic Achilles tendon (AT) tendinopathy and ruptures are coupled with remarkable functional impairment and incapacitating pain. Flexor hallucis longus (FHL) transfer is a promising surgical procedure to regain function and improve Achilles disease pain. This study aimed to explore the clinical results of FHL transfer to the AT.


Methods
From March 2020 to October 2022, 24 cases with neglected AT rupture with a considerable gap were admitted to our department. All patients were managed with open tendon debridement and transosseous FHL tendon transfers. Patients were assessed by the American Orthopedic Foot and Ankle Society hind foot score, the short form 12 question (SF-12) questionnaire.


Results
The mean age of the cohort at surgery was 47.6±5.9 years. All cases were followed-up for at least 1 year after surgery. The dimension of the defect in the tendon calculated was 5.4±0.8 cm. Regarding patient reported outcome measures, their values are conveyed in Table 2. The mean hindfoot American Orthopedic Foot and Ankle Society score improved from 56.8±5.4 presurgery to 87.8±6.4 postsurgery. The mean physical SF-12 score improved significantly form preoperative value of 36.8±5.0 to 53.5±2.8 postoperatively.


Conclusion
In conclusion, the FHL transfer for chronic Achilles tears is a harmless, reproducible, and easy technique with little risk of complications. Most patients recuperated to their previous daily doings with a high level of gratification.