Functional outcome of FHL transfer for treatment of chronic tendo Achilles (CAT) tear using single incision

Abstract

Introduction: Chronic Tendo Achilles Tears are common and surgically challenging problems. FLexor Hallucis longus transfer is used to improve pain and functional outcomes. The aim of our study is to study clinical outcome of foot and ankle post-surgery. We also aim to study the effect of FHL transfer using AOFAS Hallux scores. Materials and Methods: 24 cases were enrolled who had irreparable gap of tendon Achilles on MRI scans. 4 were lost in follow-up. 20 cases were studied. These cases had a gap between 2 cut ends of Tendo Achilles, as seen intraoperatively. The FHL was harvested by cutting distal end through the same incision. FHL cut end was sutured with whip stitch and tenodesed with a suture anchor in calcaneus at 40 degrees plantar flexion. Below Knee cast is applied. Patient was followed up at 3rd, 6th, 10th weeks. Later followed up every month. Results: The average age of patients were 56.35 years (45-68). The Male to female ratio was 13:7. 6 patients had diabetes as medical comorbidity and 50% of patients had tobacco addiction. The mean BMI of patients was 32.55 (Range 25-38). The FAOS score improved from an average score of 58.05 preoperatively (Range 38-72) to average score of 88 postoperatively (Range 77-98). Wilcoxon Signed rank test was used which suggested the results are statistically significant. The effect of FHL transfer was gauged by AOFAS Hallux score postoperatively with mean score of 85.35 (Range 76-95). Conclusion: We conclude that FHL transfer is an effective and safe method of surgical option in chronic Tendo Achilles tears, with minimal adverse effect on donor site based on AOFAS Hallux scores.