Early post-operative results of neglected tendo-Achilles rupture reconstruction using short flexor hallucis longus tendon transfer: A prospective review

Abstract Background Various repair techniques have been reported for neglected tendo-Achilles rupture. Objective This study aimed to prospectively investigate the impact of short flexor hallucis longus (FHL) transfer to the calcaneus for patients with neglected rupture secondary to trauma. Methods One surgeon operated on a series of patients with neglected tendo-Achilles rupture. Ankle function and patient health were assessed pre and post-operatively using the American Orthopaedic Foot and Ankle Score (AOFAS) and the SF-36 score. Results 11 patients (6 male; mean age 52.6) were included. Median time from injury to surgery was 13.3 weeks (range 6–104 weeks). The mean pre-operative AOFAS was 51.4 (range 26–87), 79.8 (range 64–94) at 3 months and 91.9 (range 77–100) at 6 months post-operatively. The mean pre-operative SF-36 score was 87.4 (range 75.4–109.5), 103.2 (range 74.1–115.4) at 3 months and 111.8 (range 103.9–116.2) at 6 months. All patients had improved SF-36 at 6 months. At 6 months 10 out 11 patients had resumed pre-injury daily activities. Conclusion Direct transfer of FHL to the calcaneum with an interference screw allows correct tensioning and secure fixation. The procedure has low morbidity and reliable outcomes. The majority of patients were able to return to daily working activities with no restrictions.