Primary augmentation of percutaneous repair with flexor hallucis longus tendon for Achilles tendon ruptures reduces tendon elongation and may improve functional outcome

Purpose Achilles tendon ruptures (ATR) result in loss of strength and function of the gastrosoleus—Achilles tendon complex, probably because of gradual tendon elongation and calf muscle atrophy, even after surgical repair. Flexor hallucis longus (FHL) augmentation not only reinforces the repair and...

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Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2023, Vol.31 (1), p.94-101
Main Authors: Maffulli, Nicola, Gougoulias, Nikolaos, Christidis, Panagiotis, Maffulli, Gayle D., Oliva, Francesco
Format: Article
Language:English
Subjects:
Achilles tendon
Achilles Tendon - surgery
Anesthesia
Ankle
Atrophy
Augmentation
Calcaneus
Elongation
Humans
Leg
Medicine
Medicine & Public Health
Muscle contraction
Muscles
Orthopedics
Rupture - surgery
Sports Medicine
Tendon Injuries - surgery
Tendon Transfer - methods
Tendons
Toes
Treatment Outcome
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Summary:Purpose Achilles tendon ruptures (ATR) result in loss of strength and function of the gastrosoleus—Achilles tendon complex, probably because of gradual tendon elongation and calf muscle atrophy, even after surgical repair. Flexor hallucis longus (FHL) augmentation not only reinforces the repair and provides new blood supply to the tendon, but also protects the repair, internally splinting the repaired Achilles tendon, maintaining optimal tension. We prospectively compared the clinical outcomes of patients with acute ATR, managed with either percutaneous repair only or percutaneous repair and FHL augmentation. Methods Patients with acute ATR undergoing operative management were divided into two groups. Thirty patients underwent percutaneous repair under local anesthesia, and 32 patients underwent percutaneous repair augmented by FHL tendon, harvested through a 3 cm longitudinal posteromedial incision, and transferred to the calcaneus, under epidural anesthesia. All patients were treated by a single surgeon between 2015 and 2019 and were followed prospectively for 24 months. Results The percutaneous only group was younger than the augmented one (35.4 ± 8.0 vs 40.4 ± 6.6 years, p  = 0.01) . In the augmented group, 25 patients stayed overnight and only 5 were day cases, whereas in the percutaneous only group 4 patients stayed overnight and 28 of them were day cases ( p  
ISSN:0942-2056
1433-7347
DOI:10.1007/s00167-022-07183-0