Combined flexor hallucis longus tendon transfer and gastrocnemius recession for reconstruction of gapped chronic achilles tendon ruptures.
OBJECTIVE
The aim of this study was to assess the functional outcomes after a combined FHL transfer and a gastrocnemius recession for treatment of chronic ruptures of Achilles tendon with a gap and to investigate the patient's satisfaction about the great toe function after transfer.


METHODS
19 patients with chronic rupture of the Achilles tendon with a gap were treated with a flexor halluces longus tendon transfer combined with a gastrocnemius recession, Clinical diagnosis depends on the presence of gap in the tendon on examination, inability of tip toe walking on the affected side and positive calf-squeeze test, MRI was used to confirm the clinical diagnosis. American Orthopedic Foot & Ankle Society hind foot score was used for assessment of the results.


RESULTS
The AOFAS score improved significantly from a mean of 65 preoperatively to 94 at the last follow up (p<0.001), there was no significant difference in the final outcome between patients with FHL tendon weaved through the stump of the Achilles tendon and those with trans osseous tunnels, the mean AOFAS score at the last follow up was 94.2, 93.8 respectively, no patient complained of big toe dysfunction.


CONCLUSIONS
Management of chronic rupture of the Achilles tendon with a gap with flexor halluces longus tendon transfer combined with a gastrocnemius recession is a safe and reliable method with a significantly improved functional outcome, muscle advancement through gastrocnemius recession decreases the length of the gap without affecting the muscle function, flexor halluces longus tendon transfer doesn't harm the big toe function.
Assisstant Prof of Orthopedic Surgery, Kafr Elsheikh University, Egypt. Electronic address: hatemelgohary20@yahoo.com.
Hatem Elsayed Ahmed
HEA
Elgohary
Assisstant Prof of Orthopedic Surgery, Mansoura University, Egypt. Electronic address: nelmoghazy@yahoo.com.
Nabil A
NA
Elmoghazy
Assisstant Prof of Orthopedic Surgery, Mansoura University, Egypt. Electronic address: mserry2005@yahoo.com.
Mohammed Serry
MS
Abd Ellatif
D000125:Achilles Tendon / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D002908:Chronic Disease; D004534:Egypt; D005260:Female; D006214:Hallux / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D012421:Rupture; D013708:Tendon Injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
Achilles tendon; Flexor halluces longus; Gastrocnemius recession; Transosseous tunnel