Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan.
Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
Sci Rep. 2023 Nov 22;13(1):20475. doi: 10.1038/s41598-023-47725-1.
Flexor hallucis longus (FHL) transfer is an effective surgery in treating insertional Achilles tendinopathy (IAT). However, limited data exist regarding the post-surgery changes in the transferred FHL. The study aimed to compare the sequential changes and hypertrophy of FHL after isolated FHL transfer (FHLT). We retrospectively enrolled patients who underwent isolated FHLT for insertional Achilles pathology from 2015 to 2020 and divided them into two groups based on whether reattachment of the residue Achilles stump to the FHL was performed or not. We recorded demographic characteristics, MRI parameters, and functional outcome. We also analyzed the correlation between the collected data and FHL hypertrophy. Results revealed no significant differences in most MRI parameters of FHL and functional outcomes between the groups. However, the fat distribution within the FHL showed significant reduction and notable 20.2% hypertrophy after FHLT. Interestingly, the hypertrophy of the FHL was significantly more pronounced in the non-reattached group. Furthermore, we observed a positive correlation between the follow-up period and FHL hypertrophy. In conclusion, the FHL demonstrated significant enlargement over time following FHLT. The compensatory hypertrophy of the transferred FHL was particularly evident and the cumulative incidences of FHL enlargement over time were higher in the non-reattached groupcompared to reattached group. However, both reattachment and non-reattachment of Achilles stump on FHL transfer for insertional Achilles tendinopathy carried similar postoperative functional outcomes.
（中文译文）
（标题）：探讨单纯性踇长屈肌腱转位术后的移植物变化
（摘要）：目的：比较单纯性踇长屈肌腱转位（FHLT）术后移植物的连续变化和肥大情况。方法：回顾性分析 2015 年至 2020 年因跟腱止点病变接受单纯性 FHLT 的患者，根据是否将跟腱残端重新附着到 FHL 上，将患者分为两组。记录患者的人口统计学特征、MRI 参数和功能结果。还分析了收集的数据与 FHL 肥大之间的相关性。结果：两组 FHL 的大多数 MRI 参数和功能结果无显著差异。然而，FHL 内的脂肪分布在 FHLT 后明显减少，出现明显的 20.2%的肥大。有趣的是，未重新附着组的 FHL 肥大更为明显。此外，我们观察到随访时间与 FHL 肥大之间存在正相关。结论：FHLT 后 FHL 随时间显著增大。移植物的代偿性肥大尤其明显，与重新附着组相比，未重新附着组的 FHL 随时间的累积增大发生率更高。然而，对于跟腱止点病变，FHL 转移术的重新附着和不重新附着在术后功能结果上相似。
