Tiago Soares Baumfeld, Victor Roberto Borges Barbosa, Breno Souza Dos Santos, Daniel Soares Baumfeld, Alexandre Leme Godoy-Santos, Stefan Rammelt
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The aim of this study is to analyze patient-reported questionnaires, functional capacity assessment (FCA), and re-rupture rates following endoscopic FHL transfer for acute ATR.</p><p><strong>Methods: </strong>This is a prospective case series with 26 patients (15 men, 11 women, mean age 47.7 years) who suffered an ATR and underwent surgical reconstruction with a FHL endoscopic transfer, between March 2022 and December 2023. The minimum follow-up was 12 months. Postoperative assessments included the visual analogue pain scale (VAS), Victorian Institute of Sports Assessment - Achilles (VISA-A) score, Achilles total tendon rupture score (ATRS), AOFAS, EVA, as well as plantar flexion strength, hallux flexion strength, ankle mobility, single heel rise test and Lunge test and Achilles tendon resting angle.</p><p><strong>Results: </strong>Five out of 26 patients (19,2 %) had a re-rupture of the Achilles tendon between the second and the fourth postoperative week. Twelve months postoperatively, the pain measured by VAS was 0.5, the mean VISA-A score was 94.4 (95 % CI: 90.8-100), and the mean ATRS was 5.1. The plantar flexion strength and ankle mobility were significantly lower in the affected side when compared to the formerly unaffected side (p = 0.015 and p < 0.001, respectively). No wound healing problems or neurovascular or complications were observed.</p><p><strong>Discussion: </strong>Despite a cautious rehabilitation program, we observed an unacceptably re-rupture rate of 19.2 % in our sample when compared to other techniques. We therefore believe that this technique should not be used in very active patients who desire fast recovery after acute ATR because the risks may be too high.</p><p><strong>Conclusion: </strong>Endoscopic FHL transfer appears to be associated with a high re-rupture rate when used to treat acute Achilles tendon ruptures.</p><p><strong>Evidence level: </strong>IV, Case Series.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Endoscopic flexor hallucis longus transfer for acute Achilles tendon ruptures is associated with a high re-rupture rate: A prospective case series.\",\"authors\":\"Tiago Soares Baumfeld, Victor Roberto Borges Barbosa, Breno Souza Dos Santos, Daniel Soares Baumfeld, Alexandre Leme Godoy-Santos, Stefan Rammelt\",\"doi\":\"10.1016/j.fas.2025.05.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Achilles tendon rupture (ATR) is one of the most common injuries to the musculoskeletal system. 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Postoperative assessments included the visual analogue pain scale (VAS), Victorian Institute of Sports Assessment - Achilles (VISA-A) score, Achilles total tendon rupture score (ATRS), AOFAS, EVA, as well as plantar flexion strength, hallux flexion strength, ankle mobility, single heel rise test and Lunge test and Achilles tendon resting angle.</p><p><strong>Results: </strong>Five out of 26 patients (19,2 %) had a re-rupture of the Achilles tendon between the second and the fourth postoperative week. Twelve months postoperatively, the pain measured by VAS was 0.5, the mean VISA-A score was 94.4 (95 % CI: 90.8-100), and the mean ATRS was 5.1. The plantar flexion strength and ankle mobility were significantly lower in the affected side when compared to the formerly unaffected side (p = 0.015 and p < 0.001, respectively). 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引用次数: 0
摘要
简介：跟腱断裂（ATR）是肌肉骨骼系统最常见的损伤之一。最近，内窥镜下FHL移植已成功用于治疗足球运动员的急性损伤，具有良好的恢复率和良好的功能预后。本研究的目的是分析患者报告的问卷、功能容量评估（FCA）和内镜下FHL转移治疗急性ATR后的再破裂率。方法：这是一个前瞻性病例系列，包括2022年3月至2023年12月期间26名患者（15名男性，11名女性，平均年龄47.7岁），他们患有ATR并接受了FHL内镜转移手术重建。最短随访时间为12个月。术后评估包括视觉模拟疼痛量表（VAS）、victoria Institute of Sports Assessment - Achilles （VISA-A）评分、跟腱总断裂评分（ATRS）、AOFAS、EVA，以及足底屈曲强度、拇屈曲强度、踝关节活动度、单跟上升试验、弓步试验和跟腱静息角。结果：26例患者中有5例（19.2 %）在术后第2周至第4周之间再次发生跟腱断裂。术后12个月，VAS测量疼痛为0.5，VISA-A平均评分为94.4(95 % CI: 90.8 ~ 100)， ATRS平均为5.1。与以前未受影响的一侧相比，患侧的足底屈曲强度和踝关节活动明显降低（p = 0.015和p ）讨论：尽管采取了谨慎的康复计划，但与其他技术相比，我们观察到样本中不可接受的再破裂率为19.2% %。因此，我们认为这种技术不应该用于急性ATR后希望快速恢复的非常活跃的患者，因为风险可能太高。结论：内镜下FHL转移治疗急性跟腱断裂的再破裂率较高。证据等级：IV，案例系列。
Endoscopic flexor hallucis longus transfer for acute Achilles tendon ruptures is associated with a high re-rupture rate: A prospective case series.
Introduction: Achilles tendon rupture (ATR) is one of the most common injuries to the musculoskeletal system. Recently, endoscopic FHL transfer has been successfully used to treat acute injuries in soccer players, with good return to play rates and good functional outcomes. The aim of this study is to analyze patient-reported questionnaires, functional capacity assessment (FCA), and re-rupture rates following endoscopic FHL transfer for acute ATR.
Methods: This is a prospective case series with 26 patients (15 men, 11 women, mean age 47.7 years) who suffered an ATR and underwent surgical reconstruction with a FHL endoscopic transfer, between March 2022 and December 2023. The minimum follow-up was 12 months. Postoperative assessments included the visual analogue pain scale (VAS), Victorian Institute of Sports Assessment - Achilles (VISA-A) score, Achilles total tendon rupture score (ATRS), AOFAS, EVA, as well as plantar flexion strength, hallux flexion strength, ankle mobility, single heel rise test and Lunge test and Achilles tendon resting angle.
Results: Five out of 26 patients (19,2 %) had a re-rupture of the Achilles tendon between the second and the fourth postoperative week. Twelve months postoperatively, the pain measured by VAS was 0.5, the mean VISA-A score was 94.4 (95 % CI: 90.8-100), and the mean ATRS was 5.1. The plantar flexion strength and ankle mobility were significantly lower in the affected side when compared to the formerly unaffected side (p = 0.015 and p < 0.001, respectively). No wound healing problems or neurovascular or complications were observed.
Discussion: Despite a cautious rehabilitation program, we observed an unacceptably re-rupture rate of 19.2 % in our sample when compared to other techniques. We therefore believe that this technique should not be used in very active patients who desire fast recovery after acute ATR because the risks may be too high.
Conclusion: Endoscopic FHL transfer appears to be associated with a high re-rupture rate when used to treat acute Achilles tendon ruptures.
期刊介绍：
Foot and Ankle Surgery is essential reading for everyone interested in the foot and ankle and its disorders. The approach is broad and includes all aspects of the subject from basic science to clinical management. Problems of both children and adults are included, as is trauma and chronic disease. Foot and Ankle Surgery is the official journal of European Foot and Ankle Society.
The aims of this journal are to promote the art and science of ankle and foot surgery, to publish peer-reviewed research articles, to provide regular reviews by acknowledged experts on common problems, and to provide a forum for discussion with letters to the Editors. Reviews of books are also published. Papers are invited for possible publication in Foot and Ankle Surgery on the understanding that the material has not been published elsewhere or accepted for publication in another journal and does not infringe prior copyright.
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