Background achillestendon rupture (ATR) is a widespread tendon injury that can be observed in middle-aged individuals after sporting activities or secondary to trauma. We aimed to retrospectively assess the clinical findings and radiological parameters of individuals treated with isolated endoscopic flexor hallucis longus tendon transfer (FHLT) due to chronic achillestendon ruptures (CATR) before and after surgical intervention. The working hypothesis was that, based on postoperative functional and clinical evaluation, FHLT was an effective and safe method in CATR treatment. Methods We analyzed individuals who received an ATR and underwent treatment retrospectively. Individuals who performed isolated FHLT due to CATR were included in the study. Individuals were separated into two main groups: before and after surgical intervention. In addition, grouping was performed according to force arm length and muscle volume. Functional and clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society scores (AOFAS), achillestendon rupture score (ATRS), range of motion degrees, balance performance, data after the heel rise test, force arm length after FHLT, muscle volume, and magnetic resonance imaging (MRI) scans. Results The mean degree of dorsiflexion in the extremities on the non-operated side was 23.17 ± 1.63 degrees, while in the extremities on the operated side it was 23.25 ± 1.62 degrees (p = 0.723). Preoperative mean American Orthopedic Foot and Ankle Society scores (AOFAS) and achillestendon rupture score (ATRS) scores were 60.54 ± 6.95 and 48.67 ± 9.21, respectively. Postoperatively, these scores were observed as 87.38 ± 5.44 and 88.92 ± 5.17 (p < 0.001). The mean forward jump distance was 140.58 ± 7.29 centimeters (cm) on the operated side, while it was 147.75 ± 6.42 cm on the non-operated side (p < 0.001). The mean vertical jump distance was 18.67 ± 2.01 cm on the operated side and 21.63 ± 1.01 cm on the non-operated side (p < 0.001). It was observed that there was a good negative statistically significant correlation between plantar flexion (Δ) and the flexor hallucis longus (FHL) force arm length (r=−0.659**). Conclusions Endoscopic FHL transfer is a minimally invasive surgical procedure and safe method that restores ankle function to as close to its before-injury state as possible with minimal complications through the correct technical approach, enabling early return to work and sports.

Endoscopic flexor hallucis longus transfer in the patients with chronic achilles rupture

期刊论文
出版模式：

开放获取
发表日期：

2026年1月10日

查看全文

Hüseyin Kürüm,
Adnan Akcan

摘要

Background

achillestendon rupture (ATR) is a widespread tendon injury that can be observed in middle-aged individuals after sporting activities or secondary to trauma. We aimed to retrospectively assess the clinical findings and radiological parameters of individuals treated with isolated endoscopic flexor hallucis longus tendon transfer (FHLT) due to chronic achillestendon ruptures (CATR) before and after surgical intervention. The working hypothesis was that, based on postoperative functional and clinical evaluation, FHLT was an effective and safe method in CATR treatment.

Methods

We analyzed individuals who received an ATR and underwent treatment retrospectively. Individuals who performed isolated FHLT due to CATR were included in the study. Individuals were separated into two main groups: before and after surgical intervention. In addition, grouping was performed according to force arm length and muscle volume. Functional and clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society scores (AOFAS), achillestendon rupture score (ATRS), range of motion degrees, balance performance, data after the heel rise test, force arm length after FHLT, muscle volume, and magnetic resonance imaging (MRI) scans.

Results

The mean degree of dorsiflexion in the extremities on the non-operated side was 23.17 ± 1.63 degrees, while in the extremities on the operated side it was 23.25 ± 1.62 degrees (p = 0.723). Preoperative mean American Orthopedic Foot and Ankle Society scores (AOFAS) and achillestendon rupture score (ATRS) scores were 60.54 ± 6.95 and 48.67 ± 9.21, respectively. Postoperatively, these scores were observed as 87.38 ± 5.44 and 88.92 ± 5.17 (p < 0.001). The mean forward jump distance was 140.58 ± 7.29 centimeters (cm) on the operated side, while it was 147.75 ± 6.42 cm on the non-operated side (p < 0.001). The mean vertical jump distance was 18.67 ± 2.01 cm on the operated side and 21.63 ± 1.01 cm on the non-operated side (p < 0.001). It was observed that there was a good negative statistically significant correlation between plantar flexion (Δ) and the flexor hallucis longus (FHL) force arm length (r=−0.659**).

Conclusions

Endoscopic FHL transfer is a minimally invasive surgical procedure and safe method that restores ankle function to as close to its before-injury state as possible with minimal complications through the correct technical approach, enabling early return to work and sports.