The clinical effects of V-Y advancement and flexor hallucis longus tendon transfer in the treatment of Kuwad III type chronic achilles tendon injury

Abstract

Objective To investigate the operative technique and clinical effects of V-Y advancement and flexor hallucis longus tendon transfer in the treatment of chronic achilles tendon ruptures. Methods Twenty-six patients with chronic achilles tendon ruptures treated between February 2012 and February 2013 were involved in the study, including 20 males and 6 females, at age of 22 to 58 years(average 33.6 years). The length of achilles tendon defect after intra-operative debridement is ranging from 3 to 5 cm. Limited open repair of chronic achilles tendon ruptures using V-Y advancement and flexor hallucis longus tendon transfer were performed and the healing time and complications were recorded. The pre- and postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, visual analog scale scores for pain and Leppilahti achilles tendon repair score were compared. Results Twenty-one patients were followed up for 12 to 26 months (average 16.4 months) and five cases were lost.All incisions were in primary healing, without any complications such as infection, nerve injury and secondary rupture. The average healing time of achilles tendons was 12 weeks according to MRI imaging and the average ossification time of interference screws was 18 months. At latest follow up, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved from (52.6±15.4) preoperatively to (96.8±2.5). Similarly, preoperative Visual analog scale score was (5.71±1.56), and mean postoperative Visual analog scale was (1.24±0.44). Besides, Leppilahti achilles tendon repair score was improved from (68.56±7.43) to (92.58±5.1). There were significant differences between the pre- and postoperative scores in all the three evaluations (P<0.05). Conclusions Limited open repair of chronic achilles tendon ruptures using V-Y advancement and flexor hallucis longus tendon transfer may be a good option for a defect gap ranging 3 to 5 cm. It is a safe and effective surgery due to its simpleness and less complications. Key words: Chronic achilles tendon injury; V-Y advancement; Tendon transfer; Fracture healing; Treatment outcome; Postoperative complications