Endoscopic Treatment for Chronic Achilles Tendon Rupture on High Demand Patients

Abstract

Category: Ankle, Arthroscopy, Sports, Trauma Introduction/Purpose: Chronic Achilles Tendon Rupture (CATR) is still a prevalent condition that includes neglected ruptures and re-ruptures after surgical treatment. CATR is responsible for marked functional impairment that usually requires surgical repair and an open procedure is traditionally performed. Endoscopic treatment has been described but there is no consensus in its role due to lack of quality papers. There is some experience with endoscopic transfer of Flexor Hallucis Longus (ETFHL) but most authors recommend this technique only on low demanding patients. The purpose of this paper is to present our results with ETFHL on athletic patients (recreational sports or high demanding job), contributing to the establishment of this technique. Methods: In this retrospective study, the authors report a series of 14 patients submitted to ETFHL, 12 patients due to Chronic Achilles rupture and 2 due to acute re-rupture, between May 2014 and January 2018. The mean follow-up period was 28 months (range 12 to 48 months). We measured pre and post-operative AOFAS score and Achilles Tendon Total Rupture Score (ATRS), along with post-operative heel rise height test. Results: In our 14 patients (11 male, 3 female) the mean age was 42 years old (range 23 to 59). There were 10 non-professional athletes and 4 high demand workers. The mean pre-operative AOFAS score was 61,1 (range 49 to 79) and ATRS was 11,6 (range 10 to 14). Post-operative results: the mean AOFAS score was 96 (ranging 90 to 100). All patients were able to do single foot heel rise with a mean height of 6,2 cm (range 5 to 9,6 cm). The mean ATRS was 95 (range 81 to 100). All patients showed complete functional recuperation of the gastrocnemius complex and returned to sports or labor activities at their previous level. One patient had transient hypoesthesia of tibial nerve. No other complications were registered. Conclusion: We present a small group of recreational athletes and high demand workers in which ETFHL for CATR showed good results with remarkable functional rehabilitation. Our results are comparable to open classic techniques, with less invasiveness and soft tissue complications. Our experience made us believe that ETFHL may play a role in the treatment of CATR, not only in low demand patients but also in the athletic population. Further studies are necessary to compare this technique with the open procedure to ensure its safety and efficacy.