Endoscopic flexor hallucis longus tendon transfer in treatment of achiles tendon rupture

Treatment of acute and chronic Achilles tendon ruputres is controversal topic. Non operative treatment does not provide full Achilles tendon strength. Many different options for surgical treatment exists; open direct suturing of tendon, augumentation with fascia flap or adjacent tendons of peroneus brevis (PBT) or flexor hallucis longus tendon (FHL) and percutaneous reconstruction. Treatment of athletes urges confident method, minimaly invasive approach and option that allows quick and full recovery with good tendon strength. We describe endoscopic flexor hallucis longus tendon (FHLT) transfer on calcaneal tuber and fixation with interference screw and Endobutton. Sixteen patients were operated on by a senior surgeon. There were 14 men and 2 women, average age 53 years (30-74 years, median 58 years). Six patients were operated on due to acute Achilles tendon rupture with mean period from rupture to surgery of 12 days (3-28 days, median 12 days) In 10 patients ruptures were chronic with mean period form injury to surgery of14 months (6 weeks to 48 months, median 5 months). FADI and AOFAS scores were evaluated before and six months after surgery and MRI was performed before and at least one year after surgery. The mean preoperative FADI1 was 49 (34-62, median 51), and the postoperative FADI2 was 81 (43-100, median 100). The preoperative AOFAS1 was 60 (51-79, median 68), and the postoperative AOFAS2 was 92 (76-100, median 100). Complications were; breakage of intereference screw in one patient and Endobutton plate irritation in one patient. All patients had improvement in the functional clinical status and they all returned to their prefered previous recreatonal sport activities. In all patients we found hypertrophy of FHLand homogeneous MRI image of Achilles tendon structure one year after surgery. Endoscopic FHLT transfer on calcaneal tuber is simple and reliable method for Achilles tendon function restauration in athletes with a predictable expected treatment outcome.