Endoscopic Layered Adhesiolysis of Achilles Tendon–Flexor Hallucis Longus Complex via Medial Portals After Gastrocnemius Fascial Turn‐Down Flap and Flexor Hallucis Longus Transfer for Chronic Achilles Tear

Good outcomes have been reported after gastrocnemius fascial turn-down flap with flexor hallucis longus (FHL) augmentation for chronic Achilles tendon (AT) rupture. However, postoperative peritendinous fibrous adhesions with tightness and ankle stiffness can occur because of extensive soft tissue dissection and postoperative immobilization. Adhesions can occur at the deep surface of the FHL muscle, between the AT and FHL muscle, and between the Achilles tendon and the deep fascia of the leg. The purpose of this Technical Note is to describe the details of endoscopic layered adhesiolysis of the AT-FHL complex. This minimally invasive approach allows adequate release of every plane of the complex and immediate vigorous mobilization of the foot and ankle. This technique, combined with endoscopic adhesiolysis of the muscles in the superior posterior compartment of the leg and endoscopic adhesiolysis of the AT after tendon repair, forms a comprehensive system for managing various situations after AT repair or tendon transfer. It is indicated in symptomatic fibrous adhesions of the AT-FHL complex after FHL transfer when the patient experiences pain and tightness over the operated region of the AT with corresponding tenderness and is recalcitrant to conservative treatment.