Endoscopic FHL transfer to augment Achilles disorders

Many procedures have been described for operative treatment of chronic Achilles tendon ruptures (CATR) and insertional calcificant achilles tendinosis (ICAT).This technical note describes a novel technique for the treatment or augmentation of different Achilles disorders such as CATR and ICAT, among others. A retrospective study was designed. Fifteen patients were identified and underwent an endoscopic flexor hallucis longus (FHL) transfer to augment Achilles disorders between 2015 and 2016. Patient demographics and complications were extracted from the clinical research database. The average follow-up 11.27 months. The overall success rate was 93.3%. The preoperative mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 62.27 points and 91 points after surgery. The average pain on the visual analogue scale (VAS) in the preoperative was 6.93 and 0.8 in the postoperative period. Only one patient required revision surgery (6.6%). The advantages of doing an FHL transfer include: utilisation of a vascularised tendon with a strong viable muscle, low morbidity and it represents a reproducible technique. Although it may be a good primary indication for CATR and non-insertional AT tendinopathy, it seems reasonable to be indicated in revision surgery in cases affected by ICAT.