Achilles tendon reconstruction combining a modified Dresden technique and endoscopic flexor hallucis longus transfer

Cristian Ortiz,Felipe Chaparro,Felipe Silva,Giovanni Carcuro,Manuel J Pellegrini,Mario I Escudero

doi:10.30795/jfootankle.2020.v14.1157

Cristian Ortiz, Felipe Chaparro + Show 4 more

Open Access

https://doi.org/10.30795/jfootankle.2020.v14.1157

Copy DOI

Abstract

Objective: The purpose of this paper is to describe a minimally invasive chronic Achilles tendon rupture reconstruction combining a modified Dresden technique and endoscopic flexor hallucis longus (FHL) tendon transfer. Methods: Our prospectively collected database was queried for patients presenting with chronic Achilles tendon rupture. Patients were included if they presented any of the following criteria: more than 65 years of age, history of previous DVT, active smoking habit and Diabetes. Pre and post-operative SF-36 and AOFAS hindfoot scores, complications, and patient satisfaction grades were recorded. Results: Eight patients met the inclusion criteria; the median age was 49 years old (range 22 - 67 years). Two complications were registered (sural neuritis and minor wound dehiscence). Mean AOFAS score increased from 48 (range 40 - 63) to 91,6 (range 85 - 95). Regarding SF-36 score, the SFF-36 improved from 51,6 to 79,3 points and the SFM-36 enhance from 25 to 61,5 points. All patients evaluated their satisfaction regarding the performed procedure as satisfactory. Conclusion: Chronic Achilles tendon rupture reconstruction combining a modified Dresden technique and endoscopic FHL transfer is an attractive option in high-risk patients, with favorable results at the short-term follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Highlights

Chronic Achilles tendon ruptures (CATR) can produce elongation of the Gastrocnemius-Soleus complex, generating calf soreness, muscle cramping and/or functional disability[1]
Chronic Achilles tendon rupture reconstruction combining a modified Dresden technique and endoscopic flexor hallucis longus (FHL) transfer is an attractive option in high-risk patients, with favorable results at the short-term follow-up
The purpose of this study is to present our technique to address Chronic Achilles ruptures, combining a Dresden percutaneous technique, which is usually performed for acute ruptures, and an endoscopic FHL transfer

Summary

Introduction

Chronic Achilles tendon ruptures (CATR) can produce elongation of the Gastrocnemius-Soleus complex, generating calf soreness, muscle cramping and/or functional disability[1]. Current treatment comprises some form of tendon reconstruction or tendons transfers in cases in which the muscular unit is scarred or presents severe fatty degeneration[1,2]. Minimal invasive attempts to perform these operations have been advocated, most of these procedures are still performed through open surgery. In such a scenario, most case series report good functional outcomes after any of these procedures. The patient faces a high risk of developing wound complications and infection, those presenting risk factors such as old age, diabetes, smo king history and/or peripherical vascular disease

Methods

Results

Discussion

Conclusion