1 Human Anatomy and Embriology Unit, University of Barcelona, Barcelona, Spain.
2 Foot and Ankle Unit, Hospital Quirón Barcelona and, iMove Traumatology Tres Torres, Barcelona, Spain.
Foot Ankle Int. 2018 Dec;39(12):1464-1472. doi: 10.1177/1071100718793172. Epub 2018 Aug 19.
: Operative management of chronic Achilles tendon ruptures is challenging, and numerous techniques have been described. Risk of infection and wound breakdown have been described after open techniques, and minimally invasive methods have been proposed to avoid them. The aim of this study was to describe the clinical and radiological results obtained after endoscopic flexor hallucis longus (FHL) tendon transfer in patients with chronic Achilles tendon rupture.
: Between 2012 and 2015, a total of 22 patients were endoscopically treated for chronic Achilles tendon rupture. Mean age was 69 years (range, 59-84 years). Mean follow-up was 30.5 months (range, 18-46 months). Preoperative magnetic resonance imaging (MRI) was obtained and tendon gap measured. An MRI was obtained at 9 to 12 months following surgery to evaluate Achilles tendon changes.
: Preoperative MRI examination showed a mean tendon gap of 6.3 cm (range, 3-10.7 cm). The MRI control was obtained only in 12 patients, and a normal or close to normal Achilles tendon was observed in all but 1 patient. The mean American Orthopaedic Foot & Ankle Society score increased from 55 preoperatively (range, 26-75) to 91 (range, 74-100) at final follow-up. All patients returned to their daily activities without difficulties. No patients reported complaints or symptomatic deficits of great toe flexion strength. No major complications were encountered.
: Chronic Achilles tendon ruptures were successfully treated by an all-endoscopic procedure. The endoscopically assisted FHL transfer provided excellent results while benefiting from the minimally invasive procedure advantages. However, it entailed some technical challenges and may not be suitable for less experienced surgeons.
: Level IV, retrospective case series.
慢性跟腱断裂的手术治疗具有挑战性，已经描述了许多技术。开放性手术可能会导致感染和伤口破裂，因此提出了微创方法来避免这些问题。本研究旨在描述经内镜踇长屈肌腱（FHL）转移治疗慢性跟腱断裂患者的临床和影像学结果。
2012 年至 2015 年，共有 22 例慢性跟腱断裂患者接受了内镜治疗。平均年龄 69 岁（59-84 岁）。平均随访时间为 30.5 个月（18-46 个月）。术前均行磁共振成像（MRI）检查，并测量肌腱间隙。术后 9-12 个月行 MRI 检查评估跟腱变化。
术前 MRI 检查显示平均肌腱间隙为 6.3cm（3-10.7cm）。仅 12 例患者获得 MRI 随访，除 1 例外，其余均未见异常或接近正常的跟腱。美国矫形足踝协会（AOFAS）评分从术前的 55 分（26-75 分）增加到最终随访时的 91 分（74-100 分）。所有患者均能重返日常活动，无困难。所有患者均未报告足大趾跖屈力量减弱的症状或不适。无重大并发症发生。
慢性跟腱断裂通过全内镜手术成功治疗。内镜辅助 FHL 转移术提供了良好的结果，同时受益于微创术式的优势。然而，它存在一些技术挑战，可能不适合经验较少的外科医生。
IV 级，回顾性病例系列。
