Gonçalves Sérgio, Caetano Rubén, Corte-Real Nuno
Department of Orthopaedic Surgery, Hospital Curry Cabral, Lisbon, Portugal.
Arthrosc Tech. 2015 Sep 7;4(5):e411-6. doi: 10.1016/j.eats.2015.03.017. eCollection 2015 Oct.
Flexor hallucis longus (FHL) transfer is a well-established treatment option in failed Achilles tendon (AT) repair and has been routinely performed as an open procedure. We detail the surgical steps needed to perform an arthroscopic transfer of the FHL for a chronic AT rupture. The FHL tendon is harvested as it enters in its tunnel beneath the sustentaculum tali; a tunnel is then drilled in the calcaneus as near to the AT footprint as possible. By use of a suture-passing device, the free end of the FHL is advanced to the plantar aspect of the foot. After adequate tension is applied to the construct, the tendon is fixed in place with an interference screw in an inside-out fashion. This minimally invasive approach is a safe and valid alternative to classic open procedures with the obvious advantages of preserving the soft-tissue envelope and using a biologically intact tendon.
拇长屈肌（FHL）转移术是治疗跟腱（AT）修复失败的一种成熟的治疗选择，并且一直作为开放手术常规进行。我们详细介绍了用于慢性AT断裂的FHL关节镜下转移术所需的手术步骤。在FHL肌腱进入距骨支撑突下方的隧道时进行取材；然后在跟骨上尽可能靠近AT足迹处钻出一个隧道。通过使用缝线传递装置，将FHL的游离端推进到足底。在对结构施加足够的张力后，用一枚挤压螺钉以由内向外的方式将肌腱固定到位。这种微创方法是经典开放手术的一种安全有效的替代方法，具有保留软组织包膜和使用生物完整性良好的肌腱的明显优势。
