Artikel
Long-term outcome following transosseous flexor hallucis longus tendon transfer for large Achilles tendon defects
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Autoren
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Philipp Friederichsen
- Schulthess Klinik, Zurich, Switzerland
| Veröffentlicht: | 21. Oktober 2024 |
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Gliederung
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Objectives: Chronic Achilles tendinopathy with large defects are surgically challenging. Concerns exist regarding transosseous transfer of the flexor hallucis longus (FHL) tendon due to the shortened lever arm of flexion and weakening of the big toe. The aim of this study was to demonstrate the long-term outcome of transosseous FHL transfer for the treatment of large Achilles tendon defects.
Methods: We retrospectively analyzed 28 patients who underwent FHL transfer. The extent of the defect was measured with magnetic resonance imaging before (baseline) and during the operation. Outcome parameters included the German Foot Function Index (FFI-D) evaluated at baseline and 6, 12 and 24 months postoperatively, a specific questionnaire to determine 24-month patient satisfaction, and the documentation of complications throughout the postoperative course as well as restrictions concerning plantar flexion strength of the great toe at 24 months.
Results: Mean baseline FFI-D subscores of pain (37.2) and function (52.3) improved significantly by 24 months post-surgery with lower mean subscores of 6.9 and 15.0, respectively (p < 0.001). At 24 months, 57% of patients were very satisfied and 25% were satisfied since having undergone the procedure. All patients noted a relevant improvement at the 2-year follow-up with only one stating that while they perceived the flexion weakness of their big toe, this was not accompanied by any relevant functional restriction. Lastly, we reported two patients each with minor complications of delayed wound healing and one patient who experienced a major complication of severe perifocal wound necrosis during the early postoperative period; the latter required plastic surgery with an additional skin flap. By the 2-year follow-up, all three patients were satisfied with their postoperative outcome and free of symptoms.
Conclusion: This work shows that transosseous FHL transfer is a successful surgical treatment for large defects of the Achilles tendon. The majority of patients were satisfied with the outcome of the procedure and experienced a significant improvement in both function and pain level. Flexion weakness of the big toe does not appear to be a relevant issue after FHL transfer
