Endoscopic Flexor Hallucis Longus Tendon Transfer for the Management of Chronic Achilles Tendon Ruptures: A Systematic Review

complications, including wound infection, delayed wound healing, and toe clawing.6 IntroductIonAchilles tendon ruptures typically result from trauma but can also occur spontaneously in patients with degenerated tendons. 1 Untreated Achilles tendon ruptures left for >4-6 weeks are classified as chronic injuries.2 A chronic Achilles tendon rupture (CATR) may occur due to delayed diagnosis or a failure to initiate postoperative management immediately.The operative management of CATRs is indicated and guided by the tendon gap size and patient-specific factors, including comorbidity, age, and time since tendon rupture.3 Flexor hallucis longus (FHL) tendon transfer is a well-established technique for managing CATRs with a tendon gap >5 cm. 4 Open techniques for FHL transfer are well-described and have shown good outcomes.Abuheih et al. observed a 38-point improvement in American Orthopedic Foot and Ankle Scoring System (AOFAS)hindfoot score postoperatively using the single-incision FHL transfer technique.5 A double-incision approach may also be used; however, higher complication rates make this technique less favorable.