Endoscopic FHL transfer for acute Achilles tendon rupture: A hybrid model of treatment
ESSKA Academy. Polyzos A. 11/09/19; 286370
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Endoscopic FHL transfer for acute Achilles tendon rupture: A hybrid model of treatment

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Topic: Tendons

Polyzos A., Gkoumousian K., Petrakis I., Eleftheropoulos A.
General Hospital of Naousa, Orthopaedic Surgery Department, Naousa, Greece

Introduction: Conservative treatment of acute Achilles tendon rupture has complicated rehabilitation protocols in literature while surgical treatment includes the danger of complications.
Objectives: To present our early results after using this modified endoscopic - hybrid technique for the treatment of acute Achilles tendon ruptures.
Aims: To establish this new model as a safe and confident treatment for acute Achilles tendon rupture
Methods: Between 2014 and 2018,17 patients(11 males and 6 females) with a mean age of 47 years, with acute Achilles tendon ruptures were admitted in our department.Patients with co-morbidities were not excluded.
The diagnosis was established using clinical and imaging tests,like Squeeze test and MRI. All patients underwent a hind foot endoscopy, including an endoscopic inspection and identification of the acute Achilles tendon rupture.
The FHL tendon was identified, was harvested (endoscopically), and got prepared. Under fluoroscopic and endoscopic guidance, the stump of FHL was transferred to os calcis just proximal and medial to Achilles tendon insertion. It was transfixed in a 6-7 mm tunnel using a 7-8 mm bioabsorbable screw, with the foot in a full plantar flexion position.
The end to end approximation of Achilles tendon stumps was checked endoscopically, and a below knee back slab was positioned for two weeks.
An aggressive physio program was undertaken as soon as the cast was removed. Partial weight bearing started in 2/52 time and full weight bearing in 4/52 time post-op, with the use of a removable below knee boot.Using ultrasound and or MRI the healing process of Achilles tendon was checked the 4th, the 6th, the 8th and the 12th-week postoperatively.
Results: No major complication like wound infection or failure of the tendon transfer was recorded. Healing of the ruptured Achilles tendon was achieved in all cases.
All the patients return to their normal daytime activities after 8 to 10 weeks. Single heal rise was achieved after 4 months.
Sporting activities were allowed after the 5th month postoperatively.
Conclusions: The use of FHL tendon as an "internal spring", it seems that inspire the patients and the physio team and gives them more confidence regarding the approximation of the Achilles tendon stumps. All patients declared that they could control their ankle comfortably and confidently immediately after surgery just as they could before the rupture. The satisfaction rate was high, even in the young population.
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