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The functional and dynamometer-tested results of transtendinous flexor hallucis longus transfer for neglected ruptures of the Achilles tendon at six years' follow-up.

Abstract Aims Flexor hallucis longus (FHL) tendon transfer is a well-recognized technique in the treatment of the neglected tendo Achillis (TA) rupture. Patients and Methods We report a retrospective review of 20/32 patients who had undergone transtendinous FHL transfer between 2003 and 2011 for chronic TA rupture. Their mean age at the time of surgery was 53 years (22 to 83). The mean time from rupture to surgery was seven months (1 to 36). The mean postoperative follow-up was 73 months (29 to 120). Six patients experienced postoperative wound complications. Results The mean postoperative Achilles tendon Total Rupture Score (ATRS) was 83 (40 to 100) and the mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 94.3 (82 to 100). Tegner scoring showed a mean reduction of one level from the pre-injury level of activity. There was a mean reduction of 24% (4 to 54) in dynamometer-measured strength of ankle plantarflexion, in comparison with the non-operated side. The hallux had a mean of only 40% (2 to 90) strength of plantarflexion in comparison with the contralateral side. Conclusion We conclude that transtendinous FHL transfer for neglected TA ruptures, with a long harvest to allow reattachment of the triceps surae, provides reliable long-term function and good ankle plantarflexion strength. Despite the loss of strength in hallux plantar flexion, there is little comorbidity from the FHL harvest. Cite this article: Bone Joint J 2018;100-B:584-9.
PMID
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Authors

Mayor MeshTerms
Keywords

Chronic rupture

Flexor hallucis longus tendon transfer

Neglected rupture

Tendo Achillis

Tendon transfer

Journal Title the bone & joint journal
Publication Year Start




PMID- 29701092
OWN - NLM
STAT- MEDLINE
DCOM- 20180516
LR  - 20180516
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 5
DP  - 2018 May 1
TI  - The functional and dynamometer-tested results of transtendinous flexor hallucis
      longus transfer for neglected ruptures of the Achilles tendon at six years'
      follow-up.
PG  - 584-589
LID - 10.1302/0301-620X.100B5.BJJ-2017-1053.R1 [doi]
AB  - Aims Flexor hallucis longus (FHL) tendon transfer is a well-recognized technique 
      in the treatment of the neglected tendo Achillis (TA) rupture. Patients and
      Methods We report a retrospective review of 20/32 patients who had undergone
      transtendinous FHL transfer between 2003 and 2011 for chronic TA rupture. Their
      mean age at the time of surgery was 53 years (22 to 83). The mean time from
      rupture to surgery was seven months (1 to 36). The mean postoperative follow-up
      was 73 months (29 to 120). Six patients experienced postoperative wound
      complications. Results The mean postoperative Achilles tendon Total Rupture Score
      (ATRS) was 83 (40 to 100) and the mean American Orthopaedic Foot & Ankle Society 
      (AOFAS) score was 94.3 (82 to 100). Tegner scoring showed a mean reduction of one
      level from the pre-injury level of activity. There was a mean reduction of 24% (4
      to 54) in dynamometer-measured strength of ankle plantarflexion, in comparison
      with the non-operated side. The hallux had a mean of only 40% (2 to 90) strength 
      of plantarflexion in comparison with the contralateral side. Conclusion We
      conclude that transtendinous FHL transfer for neglected TA ruptures, with a long 
      harvest to allow reattachment of the triceps surae, provides reliable long-term
      function and good ankle plantarflexion strength. Despite the loss of strength in 
      hallux plantar flexion, there is little comorbidity from the FHL harvest. Cite
      this article: Bone Joint J 2018;100-B:584-9.
FAU - Lever, C J
AU  - Lever CJ
AD  - Wirral University Teaching Hospital, Wirral, UK.
FAU - Bosman, H A
AU  - Bosman HA
AD  - Broomfield Hospital, Chelmsford, UK.
FAU - Robinson, A H N
AU  - Robinson AHN
AD  - Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge
      University Hospitals NHS Trust, Cambridge, UK.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Achilles Tendon/*injuries/physiopathology/surgery
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Chronic Disease
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Muscle Strength/physiology
MH  - Muscle Strength Dynamometer
MH  - Muscle, Skeletal/physiopathology
MH  - Range of Motion, Articular
MH  - Reconstructive Surgical Procedures
MH  - Recovery of Function
MH  - Retrospective Studies
MH  - Rupture
MH  - Tendon Injuries/physiopathology/*surgery
MH  - Tendon Transfer/*methods
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Chronic rupture
OT  - Flexor hallucis longus tendon transfer
OT  - Neglected rupture
OT  - Tendo Achillis
OT  - Tendon transfer
EDAT- 2018/04/28 06:00
MHDA- 2018/05/17 06:00
CRDT- 2018/04/28 06:00
PHST- 2018/04/28 06:00 [entrez]
PHST- 2018/04/28 06:00 [pubmed]
PHST- 2018/05/17 06:00 [medline]
AID - 10.1302/0301-620X.100B5.BJJ-2017-1053.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 May 1;100-B(5):584-589. doi:
      10.1302/0301-620X.100B5.BJJ-2017-1053.R1.