Chronic partial rupture of the Achilles tendon: The Flexor Hallucis Longus (FHL) tendon transfer: A report of two cases

Abstract

Achilles tendon injuries most commonly occur in athletes, but also in the middle-aged population practicing recreational sports. The aetiology of injury and disease of the Achilles tendon has not been completely clarified. While acute injury can be attributed to trauma, research showed that a chronic degenerative process is present in most ruptures. While there are still a lot of dilemmas when it comes to treating acute rupture, chronic rupture and disease are predominantly treated operatively. Many operative procedures can be used when treating chronic Achilles tendon diseases, such as excision of degenerative changes and tendon decompression, reconstruction using fascia lata and VY plastics, tendon transfer (Flexor Hallucis Longus - FHL, Flexor Digitorum Longus - FDL, Peroneus Brevis - PB) and allograft and synthetic graft reconstruction. The objective of the paper was to present the results of treating chronic partial Achilles tendon rupture by scar excision and FHL tendon transposition. The patients were one professional and one recreational athlete, both of whom were treated nonoperatively for a long time. They were both tested using AOFAS and ATRS tests preoperatively and postoperatively. The results showed a significant improvement of function and both patients were able to return to their usual activities. Postoperative results of AOFAS and ATRS tests were almost identical to the result on the uninjured leg. Our little series, as well as a lot of research performed by other authors, shows that an FHL tendon transposition is a safe and efficient method in treating diseases and injuries of the Achilles tendon.