Staggers Jackson R, Smith Kenneth, de C Netto Cesar, Naranje Sameer, Prasad Krishna, Shah Ashish
University of Alabama at Birmingham, 1313 13th Avenue South, Suite 207, Birmingham, AL, 35205, USA.
Int Orthop. 2018 Apr;42(4):829-834. doi: 10.1007/s00264-018-3834-x. Epub 2018 Feb 16.
Several operative techniques exist for Achilles tendinopathy. The purpose of our study was to compare the clinical and functional outcomes of flexor hallucis longus (FHL) transfer and V-Y advancement for the treatment of chronic insertional Achilles tendinopathy.
Retrospective chart review from 2010 to 2016 of patients that underwent FHL transfer or V-Y advancement for chronic insertional Achilles tendinopathy. Outcome measures were compared for these two procedures.
In total, 46 patients (49 ankles) with a mean age of 55.0 (range 33-73) years. Mean follow-up time 44.7 +/- 25.5 months. FHL group had 21 patients (21 ankles) with 89% satisfaction, 14% complication rate, final VAS of 0.4, final VISA-A of 89.1, subjective strength improvement following surgery of 78%, and 94% would recommend the procedure. V-Y group had 25 patients (28 ankles) with 74% subjective satisfaction, 21% complication rate, final VAS of 1.4, final VISA-A of 78.4, subjective strength improvement following surgery of 67%, and 84% would recommend the procedure. There was no significant difference in any of the results rates between the two groups (p > .05).
V-Y advancement is comparable to FHL transfer for the operative management of insertional Achilles tendinopathy. Though our results trend towards less satisfactory results following V-Y advancement, we found high satisfaction rates with similar functional outcomes and complication rates in both operative groups. We suggest considering V-Y advancement as a viable option for the primary treatment of chronic insertional Achilles tendinopathy in patients who may not be an ideal candidate for FHL transfer.
治疗跟腱病存在多种手术技术。本研究的目的是比较拇长屈肌（FHL）转位术和V-Y推进术治疗慢性跟腱附着点病的临床和功能结果。
对2010年至2016年因慢性跟腱附着点病接受FHL转位术或V-Y推进术的患者进行回顾性病历审查。比较这两种手术的结果指标。
共有46例患者（49个踝关节），平均年龄55.0岁（范围33 - 73岁）。平均随访时间44.7±25.5个月。FHL组有21例患者（21个踝关节），满意度为89%，并发症发生率为14%，最终视觉模拟评分（VAS）为0.4，最终美国足踝协会（VISA-A）评分89.1，术后主观力量改善率为78%，94%的患者会推荐该手术。V-Y组有25例患者（28个踝关节），主观满意度为74%，并发症发生率为21%，最终VAS为1.4，最终VISA-A为78.4，术后主观力量改善率为67%，84%的患者会推荐该手术。两组之间的任何结果率均无显著差异（p＞0.05）。
对于跟腱附着点病的手术治疗，V-Y推进术与FHL转位术效果相当。虽然我们的结果显示V-Y推进术后的结果趋势不太令人满意，但我们发现两个手术组的满意度都很高，功能结果和并发症发生率相似。我们建议，对于可能不是FHL转位术理想候选者的慢性跟腱附着点病患者，可将V-Y推进术作为主要治疗的可行选择。
