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

Abstract

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.

Outcomes of Percutaneous Achilles Repair Compared With Endoscopic Flexor Hallucis Longus Tendon Transfer to Treat Achilles Tendon Ruptures

“…This current retrospective study compared our results with that treatment to other simultaneous cohorts that had endoscopic use of FHL transfer for AATR during that same period that has been previously reported. 1,3 All patients who required operative repair for sustained midsubstance rupture of their Achilles tendon were included in the current study. Patients were informed regarding the merits and disadvantages of both techniques and independently selected their preferred surgical procedure.…”

“…Ankle plantarflexion and great toe flexion strengths were assessed using the MicroFET2 isokinetic digital dynamometer (Hoggan Health Industries, West Jordan, UT). 1,3,29 Hallux proximal interphalangeal plantarflexion power assessment was measured as described previously. 1,3,29 Additional evaluations were made for both the involved and the normal sides at 2.5 years postoperatively to provide comparative data.…”

“…1,3,29 Hallux proximal interphalangeal plantarflexion power assessment was measured as described previously. 1,3,29 Additional evaluations were made for both the involved and the normal sides at 2.5 years postoperatively to provide comparative data.…”

“…Achilles tendon elongation was assessed using the Achilles tendon resting angle (ATRA). 1,3,6 Assessments were performed during the intraoperative repair and during subsequent follow-up evaluations. 69 The primary outcome measure was the clinical evaluation by the Achilles tendon Total Rupture Score, AOFAS ankle-hindfoot score, and Tegner activity scores and to document any changes in that activity level.…”

“…10,17,19,26,39,55,59,60 Recently, an endoscopic method using isolated flexor hallucis longus (FHL) tendon transfer has been described and has also been associated with similarly good results both in less active individuals and in high professional athletes. 1,3 These studies were based on the reported success of the same technique albeit for chronic Achilles ruptures 4,22,30,62 or for management of Achilles tendinopathies. 13,65,66 The aim of this study was to compare the clinical and functional results of isolated endoscopic FHL transfer vs a percutaneous Achilles repair in the management of a series of patients with acute Achilles tendon ruptures and documenting these results at a minimum follow-up period of 30 months.…”