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• W3008662001 abstract "Many procedures have been described for operative treatment of chronic Achilles tendon ruptures (CATR) and insertional calcificant achilles tendinosis (ICAT).This technical note describes a novel technique for the treatment or augmentation of different Achilles disorders such as CATR and ICAT, among others. A retrospective study was designed. Fifteen patients were identified and underwent an endoscopic flexor hallucis longus (FHL) transfer to augment Achilles disorders between 2015 and 2016. Patient demographics and complications were extracted from the clinical research database. The average follow-up 11.27 months. The overall success rate was 93.3%. The preoperative mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 62.27 points and 91 points after surgery. The average pain on the visual analogue scale (VAS) in the preoperative was 6.93 and 0.8 in the postoperative period. Only one patient required revision surgery (6.6%). The advantages of doing an FHL transfer include: utilisation of a vascularised tendon with a strong viable muscle, low morbidity and it represents a reproducible technique. Although it may be a good primary indication for CATR and non-insertional AT tendinopathy, it seems reasonable to be indicated in revision surgery in cases affected by ICAT. Many procedures have been described for operative treatment of chronic Achilles tendon ruptures (CATR) and insertional calcificant achilles tendinosis (ICAT).This technical note describes a novel technique for the treatment or augmentation of different Achilles disorders such as CATR and ICAT, among others. A retrospective study was designed. Fifteen patients were identified and underwent an endoscopic flexor hallucis longus (FHL) transfer to augment Achilles disorders between 2015 and 2016. Patient demographics and complications were extracted from the clinical research database. The average follow-up 11.27 months. The overall success rate was 93.3%. The preoperative mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 62.27 points and 91 points after surgery. The average pain on the visual analogue scale (VAS) in the preoperative was 6.93 and 0.8 in the postoperative period. Only one patient required revision surgery (6.6%). The advantages of doing an FHL transfer include: utilisation of a vascularised tendon with a strong viable muscle, low morbidity and it represents a reproducible technique. Although it may be a good primary indication for CATR and non-insertional AT tendinopathy, it seems reasonable to be indicated in revision surgery in cases affected by ICAT. Current Techniques ”•Current techniques for the treatment of Achilles insertional and non-insertional disorders represents a challenge due to the reduced vascularisation and soft tissue coverage.•Open techniques had showed a high complication rate such as infection, skin and soft tissue retraction and residual symptoms.•Endoscopic flexor hallucis longus (FHL) transfer showed a high success rate.•Patients undergoing endoscopic FHL transfer should expect a low risk of serious complications.•Endoscopic FHL transfer represents a valid alternative for the treatment of both insertional and non-insertional disorders of Achilles tendon. •Current techniques for the treatment of Achilles insertional and non-insertional disorders represents a challenge due to the reduced vascularisation and soft tissue coverage.•Open techniques had showed a high complication rate such as infection, skin and soft tissue retraction and residual symptoms.•Endoscopic flexor hallucis longus (FHL) transfer showed a high success rate.•Patients undergoing endoscopic FHL transfer should expect a low risk of serious complications.•Endoscopic FHL transfer represents a valid alternative for the treatment of both insertional and non-insertional disorders of Achilles tendon. Many procedures have been described for operative treatment of chronic Achilles tendon ruptures (CATR).1Gossage W Kohls-Gatzoulis J Solan M Endoscopic assisted repair of chronic Achilles tendon rupture with flexor hallucis longus augmentation.Foot Ankle Int. 2010; 31: 343-34710.3113/FAI.2010.0343Crossref PubMed Scopus (14) Google Scholar, 2Maffulli N Ajis A Management of chronic ruptures of the Achilles tendon.J Bone Joint Surg Am. 2008; 90: 1348-136010.2106/JBJS.G.01241Crossref PubMed Scopus (140) Google Scholar These can be divided into open (eg, V-Y technique,3Elias I Besser M Nazarian LN et al.Reconstruction for missed or neglected Achilles tendon rupture with V-Y lengthening and flexor hallucis longus tendon transfer through one incision.Foot Ankle Int. 2007; 28: 1238-124810.3113/FAI.2007.1238Crossref PubMed Scopus (65) Google Scholar tendon augmentation such as peroneus brevis,4Maffulli N Oliva F Costa V et al.The management of chronic rupture of the Achilles tendon: minimally invasive peroneus brevis tendon transfer.Bone Joint J. 2015; 97-B: 353-35710.1302/0301-620X.97B3.33732Crossref PubMed Scopus (26) Google Scholar, 5Pintore E Barra V Pintore R et al.Peroneus brevis tendon transfer in neglected tears of the Achilles tendon.J Trauma. 2001; 50: 71-7810.1097/00005373-200101000-00013Crossref PubMed Scopus (109) Google Scholar flexor digitorum longus transfer,6Mann RA Holmes GB Seale KS et al.Chronic rupture of the Achilles tendon: a new technique of repair.J Bone Joint Surg Am. 1991; 73: 214-219Crossref PubMed Scopus (165) Google Scholar gracilis,7Batista J Maestu R Logioco L et al.Tratamiento de las rupturas crónicas del tendón de aquiles utilizando injerto autologo de isquiotibiales.Tobillo y Pie. 2016; 8: 109-114Google Scholar, 8Maffulli N Leadbetter WB Free gracilis tendon graft in neglected tears of the Achilles tendon.Clin J Sport Med. 2005; 15: 56-6110.1097/01.jsm.0000152714.05097.efCrossref PubMed Scopus (95) Google Scholar gastrocnemius turn down flap9Mulier T Pienaar H Dereymaeker G et al.The management of chronic Achilles tendon ruptures: gastrocnemius turn down flap with or without flexor hallucis longus transfer.Foot and Ankle Surgery. 2003; 9: 151-15610.1016/S1268-7731(03)00048-1Crossref Scopus (28) Google Scholar) or minimally invasive (percutaneous, endoscopic and a combination of both) techniques or a combination thereof. Flexor hallucis longu s (FHL) tendon transfer describes a valid alternative10Alhaug OK Berdal G Husebye EE et al.Flexor hallucis longus tendon transfer for chronic Achilles tendon rupture. A retrospective study.Foot Ankle Surg. 2019; 25: 30101-3010210.1016/j.fas.2018.07.002Crossref Scopus (13) Google Scholar, 11Hahn F Meyer P Maiwald C et al.Treatment of chronic Achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings.Foot Ankle Int. 2008; 29: 794-80210.3113/FAI.2008.0794Crossref PubMed Scopus (104) Google Scholar, 12Lui TH Endoscopic assisted flexor hallucis tendon transfer in the management of chronic rupture of Achilles tendon.Knee Surg Sports Traumatol Arthr. 2007; 15: 1163-116610.1007/s00167-007-0352-6Crossref PubMed Scopus (41) Google Scholar, 13Martin RL Manning CM Carcia CR et al.An outcome study of chronic Achilles tendinosis after excision of the Achilles tendon and flexor hallucis longus tendon transfer.Foot Ankle Int. 2005; 26: 691-69710.1177/107110070502600905Crossref PubMed Scopus (99) Google Scholar, 14Monroe MT Dixon DJ Beals TC et al.Plantarflexion torque following reconstruction of Achilles tendinosis or rupture with flexor hallucis longus augmentation.Foot Ankle Int. 2000; 21: 324-32910.1177/107110070002100409Crossref PubMed Scopus (39) Google Scholar, 15Wapner KL Pavlock GS Hecht PJ et al.Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer.Foot Ankle. 1993; 14: 443-44910.1177/107110079301400803Crossref PubMed Scopus (270) Google Scholar, 16Den Hartog BD Flexor hallucis longus transfer for chronic Achilles tendonosis.Foot Ankle Int. 2003; 24: 233-23710.1177/107110070302400306Crossref PubMed Scopus (129) Google Scholar, 17Schon LC Shores JL Faro FD et al.Flexor hallucis longus tendon transfer in treatment of Achilles tendinosis.J Bone Joint Surg Am. 2013; 95: 54-6010.2106/JBJS.K.00970Crossref PubMed Scopus (52) Google Scholar, 18Wilcox DK Bohay DR Anderson JG Treatment of chronic Achilles tendon disorders with flexor hallucis longus tendon transfer/augmentation.Foot Ankle Int. 2000; 21: 1004-101010.1177/107110070002101204Crossref PubMed Scopus (157) Google Scholar, 19Pendse A Kankate R Reconstruction of chronic Achilles tendon ruptures in elderly patients, with vascularized flexor hallucis longus tendon transfer using single incision technique.Acta Orthop Belg. 2019; 85: 137-143PubMed Google Scholar to reconstruct CATR and has shown good-to-excellent outcomes. Recently, some authors showed endoscopic procedures to FHL transfer.20Husebye EE Molund M Hvaal KH et al.Endoscopic transfer of flexor Hallucis longus tendon for chronic Achilles tendon rupture: technical aspects and short-time experiences.Foot Ankle Spec. 2018; 11: 461-46610.1177/1938640017754234Crossref PubMed Scopus (8) Google Scholar, 21Vega J Vilá J Batista J et al.Endoscopic flexor Hallucis longus transfer for chronic Noninsertional Achilles tendon rupture.Foot Ankle Int. 2018; 39: 1464-147210.1177/1071100718793172Crossref PubMed Scopus (21) Google Scholar Also, augmentation of the Achilles tendon after debridement and exostectomy for insertional calcificant achilles tendinosis (ICAT)22Clain MR Baxter DE Achilles tendinitis.Foot Ankle. 1992; 13: 482-48710.1177/107110079201300810Crossref PubMed Scopus (143) Google Scholar, 23McGarvey WC Palumbo RC Baxter DE et al.Insertional Achilles tendinosis: surgical treatment through a central tendon splitting approach.Foot Ankle Int. 2002; 23: 19-2510.1177/107110070202300104Crossref PubMed Scopus (150) Google Scholar has become an effective procedure24Oshri Y Palmanovich E Brin YS et al.Chronic insertional Achilles tendinopathy: surgical outcomes.Muscles Ligaments Tendons J. 2012; 2: 91-95PubMed Google Scholar, 25Howell MA McConn TP Saltrick KR et al.Calcific insertional Achilles Tendinopathy-Achilles repair with flexor Hallucis longus tendon transfer: case series and surgical technique.J Foot Ankle Surg. 2019; 58: 236-24210.1053/j.jfas.2018.08.021Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 26Hunt KJ Cohen BE Davis WH et al.Surgical treatment of insertional Achilles tendinopathy with or without flexor Hallucis longus tendon transfer: a prospective, randomized study.Foot Ankle Int. 2015; 36: 998-100510.1177/1071100715586182Crossref PubMed Scopus (55) Google Scholar despite the fact that in most cases this is considered for revision surgery. This study describes a novel technique for the treatment or augmentation of different Achilles disorders such as CATR and ICAT, among others. A retrospective study was designed. Fifteen patients were identified and underwent an endoscopic FHL transfer to augment Achilles disorders between 2015 and 2016 (table 1). Patient demographics and complications were extracted from the clinical research database.Table 1Patient demographics and diagnosisPatient no.GenderAge (years)ActivityRisk factorsConditionSymptomsProfessional 1M49SoccerNoHaglund+ICATChronic pain 2M22HockeyNoHaglund+ICATChronic pain 3M25HockeyNoHaglund+ICATChronic pain 4M29SoccerCTHaglung+ICATChronic pain+dysfunctionCasual sport/no sport 5M67SedentaryHTAHaglund+ICATChronic pain+dysfunction 6M53TennisNoHaglund+ICATChronic pain 7M66SedentaryNoAchilles chronic ruptureDysfunction 8F65SedentaryCT/HCAchilles chronic ruptureChronic pain+dysfunction 9M35SoccerCT/drugsHaglund+ICATChronic pain 10M32SoccerNoHaglund+ICATChronic pain 11M51SoccerNoHaglund+ICATChronic pain+dysfunction 12M38SoccerCTHaglund+ICATChronic pain+dysfunction 13M48TriathlonNoHaglund+ICATChronic pain 14M55TennisNoHaglund+ICATChronic pain 15M40Motor racingNoHaglund+ICATChronic pain+dysfunctionMedian 45 CT, chronic tobacco abuse; FU, follow-up; HC, hypercholesterolaemia; ICAT, insertional calcificant achilles tendinosis. Open table in a new tab CT, chronic tobacco abuse; FU, follow-up; HC, hypercholesterolaemia; ICAT, insertional calcificant achilles tendinosis. 1.Chronic TA ruptures.2.Non-insertional TA tendinopathy with an injury greater than 50% (cases not included on study).3.Haglund deformity+ICAT.4.Interval since the onset of symptoms and surgery between 1 and 8 weeks following an initial trial of conservative treatment. •Minimally invasive surgery.•FHL provides a tendon which is on average 8–10 cm long and 4–5 mm in diameter, allowing sufficient augmentation.27Tashjian RZ Hur J Sullivan RJ et al.Flexor Hallucis longus transfer for repair of chronic Achilles tendinopathy.Foot Ankle Int. 2003; 24: 673-67610.1177/107110070302400903Crossref PubMed Scopus (56) Google Scholar, 28Thermann H Hüfner T Tscherne H [Achilles tendon rupture].Orthopade. 2000; 29: 0235-025010.1007/s001320050442PubMed Google Scholar, 29van Dijk CN Scholten PE Krips R A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.Arthroscopy. 2000; 16: 871-87610.1053/jars.2000.19430Abstract Full Text Full Text PDF PubMed Scopus (401) Google Scholar•The long, distal reaching muscle belly of the FHL brings well vascularised muscle tissue to the critical area of the Achilles tendon 2–6 cm proximal to the calcaneal insertion, which is relative avascular.25Howell MA McConn TP Saltrick KR et al.Calcific insertional Achilles Tendinopathy-Achilles repair with flexor Hallucis longus tendon transfer: case series and surgical technique.J Foot Ankle Surg. 2019; 58: 236-24210.1053/j.jfas.2018.08.021Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 27Tashjian RZ Hur J Sullivan RJ et al.Flexor Hallucis longus transfer for repair of chronic Achilles tendinopathy.Foot Ankle Int. 2003; 24: 673-67610.1177/107110070302400903Crossref PubMed Scopus (56) Google Scholar•Easy harvesting of FHL.14Monroe MT Dixon DJ Beals TC et al.Plantarflexion torque following reconstruction of Achilles tendinosis or rupture with flexor hallucis longus augmentation.Foot Ankle Int. 2000; 21: 324-32910.1177/107110070002100409Crossref PubMed Scopus (39) Google Scholar, 27Tashjian RZ Hur J Sullivan RJ et al.Flexor Hallucis longus transfer for repair of chronic Achilles tendinopathy.Foot Ankle Int. 2003; 24: 673-67610.1177/107110070302400903Crossref PubMed Scopus (56) Google Scholar•Minimally increased operation time.•No additional surgical approach or wound site.•Cost-saving and time-saving.•Operation technique might vary depending on surgeon's experience. •Endoscopic learning curve.•Minimal risk of non-integration of the tendon into the calcaneus.•Need to perform endoscopic calcaneoplasty in order build the calcaneal hole under direct visualisation. •Chronic AT tendinopathy with tendon insufficiency in the elderly patient.•Non-insertional AT tendinopathy with degeneration greater than 50% of the tendon diameter (not included on this study).•ICAT with >50% involvement of the insertion. •Acute and chronic infections.•Systemic immunodeficiency or chemotherapy.•Severe bone-loss or bone-defects.•Severe anatomical deformities or abnormalities. •Re-operation.•Superficial or deep infection.•Thrombosis, embolism, vascular or nerve damage. •Ankle X-ray and MRI.•Shaving of the complete ankle region.•Ankle range of motion.•Single shot intravenous antibiotic administration (bone consistently, at least 30 min prior to the skin cut, ie, cephalothin). •4.0 mm, 30° angulation arthroscope.•Saline irrigation. •Spinal (preferred) or general anaesthesia.•Prone position.•Pneumatic tourniquet applied proximal to the knee.•Positioning the ankle on the edge of the table with a 5 cm silicone support under the distal leg.•Regular prepping and wrapping. The procedure was carried through the posteromedial (PM) and posterolateral (PL) portals described by van Dijk.29van Dijk CN Scholten PE Krips R A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.Arthroscopy. 2000; 16: 871-87610.1053/jars.2000.19430Abstract Full Text Full Text PDF PubMed Scopus (401) Google Scholar According to the technique described and after making the first portal (figure 1), a mosquito clamp is introduced and directed toward the arthroscope shaft until the tip of the mosquito clamp could be visualised (‘90° technique‘). A 4.0 mm (30°) arthroscope was introduced through the PL portal (figure 2). The PL portal was used as the vision portal, and the PM portal as the working portal. The PM portal was made just 2 mm medial to the Achilles tendon. In the horizontal plane, it was located at the same level as the PL portal. Using a #11 surgical blade to make perform the skin incision, a mosquito clamp was introduced and directed toward the arthroscope shaft until the tip of the mosquito clamp could be visualised. The retro Achilles fascia and the ligament of Rouvière and Canela30Rouvière H Canela M Le ligament peronéo-astragalo-calcanéen (the fibulotalocalcaneal ligament).Ann Anat Pathol. 1932; 9: 745-750Google Scholar were resected as high as possible.Figure 2Localisation of posteromedial portal.View Large Image Figure ViewerDownload (PPT) Release of the FHL involves detachment of the flexor retinaculum from the posterior talar process. Adhesions surrounding the flexor tendon should be removed (figure 3). The FHL tendon can be cut at zone 1 or 2. It is our preference to harvest the graft in zone 1 under direct posterior arthroscopic visualisation just before its entrance into the fibro-osseous sheath (figure 4). FHL tendon length for transposition into the calcaneal bone should not be less than 20 mm. The ankle and metatarsophalangeal joint were fully plantarflexed and through the PM portal a grasper was introduced to take the FHL tendon and retract it slid it proximally in order to obtain the maximum tendon length. The tendon was cut with a blade or arthroscopic scissors introduced through the PL portal (Figure 5, Figure 6). A Krackow suture is applied al the FHL distal tendon (figure 7). An endoscopic calcaneoplasty was performed in all patients to remove the posterosuperior edge of the calcaneal bone (figure 8).Figure 4Axial traction of flexor hallucis longu s in order to gain length.View Large Image Figure ViewerDownload (PPT)Figure 5Flexor hallucis longu s complete release from the distal end.View Large Image Figure ViewerDownload (PPT)Figure 6Flexor hallucis longu s sectioned and grabbed with mosquito clamp.View Large Image Figure ViewerDownload (PPT)Figure 7A Krackow suture is applied.View Large Image Figure ViewerDownload (PPT)Figure 8Endoscopic calcaneoplasty completed.View Large Image Figure ViewerDownload (PPT) By palpation of the posterior calcaneal tuberosity a central portal must be performed. Calcaneal tunnel should be done with a 7 mm drill in a dorsal to plantar direction under direct arthroscopic visualisation. Then, the FHL tendon is passed from the PM portal to the central portal and then through the calcaneal bone tunnel in a plantar direction (figure 9A–C). The FHL tendon is fixed with a 7 mm biotenodesis screw in neutral flexion (90°) (figure 10A–C). Finally, the transferred tendon is visualised and palpated through the PM and PL portal in order to be sure of the of the stable fixation and correct position (figure 11).Figure 10The flexor hallucis longu s tendon is fixed with a 7-mm biotenodesis screw in neutral flexion (90º).View Large Image Figure ViewerDownload (PPT)Figure 11Final endoscopic control. Transferred tendon is visualised and palpated through the posteromedial portal and posterolateral portal in order to be sure of the of the stable fixation and correct position.View Large Image Figure ViewerDownload (PPT) •Removal of stitches after 12–14 days.•Anti-inflammatory medication on demand.•90° short leg cast for 4 weeks.•First week: not weight bear.•Second week: partial weight bearing.•Third and fourth week: full weight bearing. •Arthroscopic learning curve is necessary in order to avoid iatrogenic lesions (nerves and tendons).•In order to avoid lack of dorsiflexion on the post op, is recommended to stabilise the ankle in 90°. The average follow-up was 11.27 months. The overall success rate was 93.3%. The preoperative mean AOFAS score was 62.27 points and 91 points after surgery. The average pain on the visual analogue scale (VAS) in the preoperative was 6.93 and 0.8 in the postoperative period. Although a high global complication rate was observed (20%) (table 2), only one patient required revision surgery (6.6%).Table 2Individual resultsPatient no.FU (months)VAS Pr.VAS Po.Thompson Pr.Thompson Po.SHRT Pr.SHRT Po.AOFAS (Pr.)AOFAS (Po.)ComplicationsProfessional 1771–––+6288None 2970––++6090None 3850––++6092None 42282––++6090Re-rupture (5 months Po.)Casual sport/no sport 5890––++6291None 6760–+–+6089None 71280+––+5890None 8681 ––+6593None 91475––++6575Osteosynthesis intolerance 101280––++65100None 11870–––+62100None 12760–––+6387Superficial infection 132050––++6290None 14961––++65100None 152072–––+6590NoneMedian11.276.9333333330.8 62.2791 Po, postoperative; Pr, preoperative; SHRT, single heel rise test; VAS, visual analogue scale. Open table in a new tab Po, postoperative; Pr, preoperative; SHRT, single heel rise test; VAS, visual analogue scale. Numerous authors have demonstrated the benefit of FHL transfer for the treatment of CATR10Alhaug OK Berdal G Husebye EE et al.Flexor hallucis longus tendon transfer for chronic Achilles tendon rupture. A retrospective study.Foot Ankle Surg. 2019; 25: 30101-3010210.1016/j.fas.2018.07.002Crossref Scopus (13) Google Scholar, 11Hahn F Meyer P Maiwald C et al.Treatment of chronic Achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings.Foot Ankle Int. 2008; 29: 794-80210.3113/FAI.2008.0794Crossref PubMed Scopus (104) Google Scholar, 12Lui TH Endoscopic assisted flexor hallucis tendon transfer in the management of chronic rupture of Achilles tendon.Knee Surg Sports Traumatol Arthr. 2007; 15: 1163-116610.1007/s00167-007-0352-6Crossref PubMed Scopus (41) Google Scholar, 13Martin RL Manning CM Carcia CR et al.An outcome study of chronic Achilles tendinosis after excision of the Achilles tendon and flexor hallucis longus tendon transfer.Foot Ankle Int. 2005; 26: 691-69710.1177/107110070502600905Crossref PubMed Scopus (99) Google Scholar, 14Monroe MT Dixon DJ Beals TC et al.Plantarflexion torque following reconstruction of Achilles tendinosis or rupture with flexor hallucis longus augmentation.Foot Ankle Int. 2000; 21: 324-32910.1177/107110070002100409Crossref PubMed Scopus (39) Google Scholar, 15Wapner KL Pavlock GS Hecht PJ et al.Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer.Foot Ankle. 1993; 14: 443-44910.1177/107110079301400803Crossref PubMed Scopus (270) Google Scholar, 16Den Hartog BD Flexor hallucis longus transfer for chronic Achilles tendonosis.Foot Ankle Int. 2003; 24: 233-23710.1177/107110070302400306Crossref PubMed Scopus (129) Google Scholar, 17Schon LC Shores JL Faro FD et al.Flexor hallucis longus tendon transfer in treatment of Achilles tendinosis.J Bone Joint Surg Am. 2013; 95: 54-6010.2106/JBJS.K.00970Crossref PubMed Scopus (52) Google Scholar, 18Wilcox DK Bohay DR Anderson JG Treatment of chronic Achilles tendon disorders with flexor hallucis longus tendon transfer/augmentation.Foot Ankle Int. 2000; 21: 1004-101010.1177/107110070002101204Crossref PubMed Scopus (157) Google Scholar, 19Pendse A Kankate R Reconstruction of chronic Achilles tendon ruptures in elderly patients, with vascularized flexor hallucis longus tendon transfer using single incision technique.Acta Orthop Belg. 2019; 85: 137-143PubMed Google Scholar, 20Husebye EE Molund M Hvaal KH et al.Endoscopic transfer of flexor Hallucis longus tendon for chronic Achilles tendon rupture: technical aspects and short-time experiences.Foot Ankle Spec. 2018; 11: 461-46610.1177/1938640017754234Crossref PubMed Scopus (8) Google Scholar, 21Vega J Vilá J Batista J et al.Endoscopic flexor Hallucis longus transfer for chronic Noninsertional Achilles tendon rupture.Foot Ankle Int. 2018; 39: 1464-147210.1177/1071100718793172Crossref PubMed Scopus (21) Google Scholar and ICAT.24Oshri Y Palmanovich E Brin YS et al.Chronic insertional Achilles tendinopathy: surgical outcomes.Muscles Ligaments Tendons J. 2012; 2: 91-95PubMed Google Scholar, 25Howell MA McConn TP Saltrick KR et al.Calcific insertional Achilles Tendinopathy-Achilles repair with flexor Hallucis longus tendon transfer: case series and surgical technique.J Foot Ankle Surg. 2019; 58: 236-24210.1053/j.jfas.2018.08.021Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 26Hunt KJ Cohen BE Davis WH et al.Surgical treatment of insertional Achilles tendinopathy with or without flexor Hallucis longus tendon transfer: a prospective, randomized study.Foot Ankle Int. 2015; 36: 998-100510.1177/1071100715586182Crossref PubMed Scopus (55) Google Scholar Likewise, there is no doubt that endoscopic procedures are gaining adherents. In relation to this we must highlight at least three studies. Vega et al 21Vega J Vilá J Batista J et al.Endoscopic flexor Hallucis longus transfer for chronic Noninsertional Achilles tendon rupture.Foot Ankle Int. 2018; 39: 1464-147210.1177/1071100718793172Crossref PubMed Scopus (21) Google Scholar showed excellent results (AOFAS from 55 preoperatively to 91 preoperatively on average) in 22 patients who were endoscopically treated for CATR. Husebye et al 20Husebye EE Molund M Hvaal KH et al.Endoscopic transfer of flexor Hallucis longus tendon for chronic Achilles tendon rupture: technical aspects and short-time experiences.Foot Ankle Spec. 2018; 11: 461-46610.1177/1938640017754234Crossref PubMed Scopus (8) Google Scholar found that five of six patients managed single leg heel raise on the affected side 12 months after surgery. The authors presented no wound healing disorders or infections. Fourteen patients were male; although this data makes it difficult to generalise the extrapolation of the results, the indications may make it possible. Although there are several studies that support the treatment of ICAT by open FHL transfer, there is a lack of data from minimally invasive procedures. Our study shows very good-to-excellent clinical and functional results. Despite the global complication rate was high, only one altered the quality of life of the patients and it was the only one that needed revision surgery. Finally, endoscopic FHL transfer might be a valid procedure when treating Achilles tendinosis11Hahn F Meyer P Maiwald C et al.Treatment of chronic Achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings.Foot Ankle Int. 2008; 29: 794-80210.3113/FAI.2008.0794Crossref PubMed Scopus (104) Google Scholar, 31Cottom JM Hyer CF Berlet GC et al.Flexor Hallucis tendon transfer with an interference screw for chronic Achilles Tendinosis.Foot Ankle Spec. 2008; 1: 280-28710.1177/1938640008322690Crossref PubMed Scopus (35) Google Scholar, 32DeCarbo WT Hyer CF Interference screw fixation for flexor hallucis longus tendon transfer for chronic Achilles tendonopathy.J Foot Ankle Surg. 2008; 47: 69-7210.1053/j.jfas.2007.09.001Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 33Elias I Raikin SM Besser MP et al.Outcomes of chronic insertional Achilles tendinosis using FHL autograft through single incision.Foot Ankle Int. 2009; 30: 197-20410.3113/FAI.2009.0197Crossref PubMed Scopus (74) Google Scholar because it already showed improvement on clinical and functional outcomes when doing the procedure by means of open surgery. The advantages of doing an FHL transfer include: utilisation of a vascularised tendon with a strong viable muscle, low morbidity and it represents a reproducible technique. Although it may be a good primary indication for CATR and non-insertional AT tendinopathy, it seems reasonable to be indicated in revision surgery in cases affected by ICAT." @default.
• W3008662001 created "2020-03-06" @default.
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• W3008662001 date "2020-03-01" @default.
• W3008662001 modified "2023-10-06" @default.
• W3008662001 title "Endoscopic FHL transfer to augment Achilles disorders" @default.
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• W3008662001 doi "https://doi.org/10.1136/jisakos-2019-000395" @default.
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