Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures: A Prospective Case Series Report With a Minimum of 18 Months’ Follow-Up

Batista, Jorge; Abdelatif, Nasef Mohamed Nasef; Vecchio, Jorge Javier Del; Diniz, Pedro; Pereira, H. de M.

doi:10.1053/j.jfas.2019.12.008

Cited by 10 publications

(42 citation statements)

References 66 publications

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“…19,27e29 Another factor may be the benefits of the well vascularized FHL muscle bulk coming into proximity of the relatively avascular portion of the AT, resulting in integration to, and repair of the AT over time. 27,30 By advancing the FHL tendon until the muscle contacts the mouth of the bone tunnel, as described in our methods, this beneficial effect would be maximised. These processes could therefore be considered to result in biological AT reconstruction, and support use of a technique where no surgical AT reconstruction in performed in addition to the FHL augmentation.…”

Section: Discussionmentioning

confidence: 99%

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Patient reported outcomes and satisfaction following single incision Flexor Hallucis Longus (FHL) augmentation for chronic Achilles tendon pathologies

Yassin

Gupta

Martins

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: Various procedures exist to augment or reconstruct the Achilles tendon (AT) in patients suffering from chronic pathologies. The aim of this study is to assess patient reported outcomes and satisfaction following single incision FHL augmentation using a short tendon harvest with interference screw fixation. Methods: This is a multicentre case series where postoperative patient reported outcome and satisfaction scores were collected on 30 patients. Outcome measures included EQ-5D, EQ-VAS, Achilles Tendon Rupture Scores (ATRS), and satisfaction scores. Scores were also collected on the unaffected limbs for comparison. Results: Mean patient age was 61 years (range 40e79, SD 11). Mean EQ-5D index value was 0.750 (0.100 e1.00, SD 0.238), and mean EQ-VAS score was 74 (36e99, SD 15), at a mean follow-up of 57 months (4 e118, SD 32). For patients with !24 months' follow-up, a mean deficit of 16 ATRS points was found between the operated and unaffected limb. Overall satisfaction was over 86%. In cases of chronic AT rupture, younger age and increasing time from initial injury to surgery were predictors of greater residual deficit. No serious complications or failures occurred. Conclusions: FHL augmentation using short tendon harvest and interference screw fixation is a safe treatment option. It appears to take at least 24 months to functionally recover following this procedure, and despite a residual function deficit, there is a high level of patient satisfaction. Further studies are required to determine optimal patient selection and timing of surgery.

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Section: Discussionmentioning

confidence: 99%

“…24 It may be that the biological benefits of FHL transfer described above are most beneficial when performed during the earlier stages of remodelling following AT rupture. 30,31 Fig. 3.…”

Section: Discussionmentioning

confidence: 99%

Patient reported outcomes and satisfaction following single incision Flexor Hallucis Longus (FHL) augmentation for chronic Achilles tendon pathologies

Yassin

Gupta

Martins

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…The procedure was performed under epidural anesthesia, with the patient in a prone position using posterior ankle endoscopy through the 2 classic portals described by van Dijk 74 (Figure 1). The operative procedure was performed in a manner exactly similar to that described previously by Batista et al 4 The step-by-step description of this surgical technique was not the focus of the current work; the reader is referred to the aforementioned article if further explanation is required. 4 However, a few operative and technical points are worth mentioning.…”

Section: Operative Techniquementioning

confidence: 99%

“…The operative procedure was performed in a manner exactly similar to that described previously by Batista et al 4 The step-by-step description of this surgical technique was not the focus of the current work; the reader is referred to the aforementioned article if further explanation is required. 4 However, a few operative and technical points are worth mentioning. Following standard posterior ankle endoscopy, the FHL tendon was identified.…”

Section: Operative Techniquementioning

confidence: 99%

“…23,26,27,63,70,72 The use of endoscopic flexor hallucis longus transfer for the management of acute cases of Achilles ruptures was recently introduced and reported to have encouraging results that are comparable to those from other minimally invasive operative methods described in the literature. 4 However, that original case report was directed at mixed cohorts of active and nonathletic populations.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures in Professional Soccer Players

Abdelatif

Batista²

2021

Foot Ankle Int.

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Background: Acute Achilles tendon ruptures (AATRs) that occur in athletes can be a career-ending injury. The aim of this study was to describe return to play and clinical outcomes of isolated endoscopic flexor hallucis longus (FHL) transfer in active soccer players with AATR. Methods: Twenty-seven active male soccer players who underwent endoscopically assisted FHL tendon transfer for acute Achilles tendon ruptures were included in this study. Follow up was 46.2 (±10.9) months after surgery. Return to play criteria and clinical outcome measures were evaluated. Results: All players returned to playing professional competitive soccer games. Return to active team training was at a mean of 5.8 (±1.1) months postoperatively. However, return to active competitive match play occurred at a mean of 8.3 (±1.4) months. Twenty-two players (82%) were able to return to their preinjury levels and performances and resumed their professional careers at the same soccer club as their preinjury state. One player (3.7%) shifted his career to professional indoor soccer. At 26 months postoperatively, the mean Tegner activity scale score was 9.7 (±0.4), the mean Achilles tendon total rupture score was 99 (±2), and the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot score was 99 (±3). No patients reported any great toe complaints or symptomatic deficits of flexion strength. Conclusion: The current study demonstrated satisfactory and comparable return to play criteria and clinical results with minimal complications when using an advanced endoscopically assisted technique involving FHL tendon transfer to treat acute Achilles tendon ruptures in this specific subset of patient cohort. Level of Evidence: Level II, prospective cohort case series study.

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Early analysis shows that endoscopic flexor hallucis longus transfer has a promising cost-effectiveness profile in the treatment of acute Achilles tendon ruptures

Diniz

Ferreira

Figueiredo³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Current options for treating an Achilles tendon rupture (ATR) include conservative and surgical approaches. Endoscopic lexor hallucis longus (FHL) transfer has been recently proposed to treat acute ruptures, but its cost-efectiveness potential remains to be evaluated. Therefore, the objective of this study was to perform an early cost-efectiveness analysis of endoscopic FHL transfer for acute ATRs, comparing the costs and beneits of current treatments from a societal perspective. Methods A conceptual model was created, with a decision tree, to outline the main health events during the treatment of an acute ATR. The model was parameterized using secondary data. A systematic review of the literature was conducted to gather information on the outcomes of current treatments. Data related to outcomes of endoscopic FHL transfers in acute Achilles ruptures was obtained from a single prospective study. Analysis was limited to the two irst years. The incremental cost-efectiveness ratio was the main outcome used to determine the preferred strategy. A willingness-to-pay threshold of $100,000 per quality-adjusted life-year was used. Sensitivity analyses were performed to determine whether changes in input parameters would cause signiicant deviation from the reference case results. Speciically, a probability sensitivity analysis was conducted using Monte Carlo simulations, and a one-way sensitivity analysis was conducted by sequentially varying each model parameter within a given range. Results For the reference case, incremental cost-efectiveness ratios exceeded the willingness-to-pay threshold for all the surgical approaches. Overall, primary treatment was the main cost driver. Conservative treatment showed the highest direct costs related to the treatment of complications. In the probabilistic sensitivity analysis, at a willingness-to-pay threshold of $100,000, open surgery was cost-efective in 50.9%, minimally invasive surgery in 55.8%, and endoscopic FHL transfer in 72% of the iterations. The model was most sensitive to parameters related to treatment utilities, followed by the costs of primary treatments. Conclusion Surgical treatments have a moderate likelihood of being cost-efective at a willingness-to-pay threshold of $100,000, with endoscopic FHL transfer showing the highest likelihood. Following injury, interventions to improve healthrelated quality of life may be better suited for improved cost-efectiveness. Level of evidence Level III.

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Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures: A Prospective Case Series Report With a Minimum of 18 Months’ Follow-Up

Cited by 10 publications

References 66 publications

Patient reported outcomes and satisfaction following single incision Flexor Hallucis Longus (FHL) augmentation for chronic Achilles tendon pathologies

Patient reported outcomes and satisfaction following single incision Flexor Hallucis Longus (FHL) augmentation for chronic Achilles tendon pathologies

Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures in Professional Soccer Players

Early analysis shows that endoscopic flexor hallucis longus transfer has a promising cost-effectiveness profile in the treatment of acute Achilles tendon ruptures

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