CME OnDemand: 2022 AOFAS Annual Meeting-Chronic Achilles Tendon Repair: Minimally Invasive Turn-Down Technique with Flexor Hallucis Longus Tendon Transfer

Chronic Achilles Tendon Repair: Minimally Invasive Turn-Down Technique with Flexor Hallucis Longus Tendon Transfer

Pdf Summary

Chronic Achilles tendon injuries present technical challenges due to delayed diagnosis, treatment, or failed repair. These injuries are commonly seen in young males and can lead to missed diagnoses. The main problem with chronic ruptures is tendon retraction, which prevents direct end-to-end repair. Different methods have been proposed to address this, including central turndowns, V-Y lengthening, grafting, and tendon transfer. However, there is no consensus on the optimal treatment.<br /><br />One technique described in this document is a turndown technique with flexor hallucis longus (FHL) tendon transfer augmentation. The procedure begins with a midline incision down the back of the calf, followed by dissection to the Achilles rupture site. Scar tissue and non-viable tendon ends are removed, and the proximal tendon segment is mobilized. The residual gap is measured, and a proximal incision is made above the tip of the proximal end. A quadriceps tendon harvester is used to cut a cylindrical graft, leaving 1cm of tendon spared distally. The tendon graft is then flipped anteriorly underneath the proximal stump, and a percutaneous achilles repair system is used to pass suture tapes through the proximal tendon. The FHL tendon transfer is performed, and two calcaneus tunnels are drilled and tapped for distal anchor sites. Sutures from the proximal tendon are passed through the distal end, and the repair is completed with bioabsorbable anchors.<br /><br />Chronic Achilles tendon injuries are often missed and require complex surgical techniques for repair. The turndown technique with FHL tendon transfer augmentation described in this document offers a minimally invasive approach while minimizing the risk of wound complications and infection. However, further research is needed to determine the optimal treatment for chronic Achilles tendon ruptures.

Asset Subtitle

Andrew Meyers, DO, Casey W. Pyle, DO

Keywords

Chronic Achilles tendon injuries

treatment

failed repair

tendon retraction

turndown technique

FHL tendon transfer

minimally invasive approach

wound complications

infection

research