Endoscopic assisted flexor hallucis tendon transfer in the management of chronic rupture of Achilles tendon

Operative treatment is indicated in the management of chronic Achilles tendon rupture. Reconstruction of chronic Achilles tendon rupture can be classified into end-to-end repair, tendo Achilles advancement or flap reconstruction, local tendon transfer and implantation with autografts, allografts or synthetic materials. Following debridement of the tendon ends and with retraction of the proximal tendon fragment, a large gap will be present and direct tendon apposition with physiological tension is usually not possible. Flexor hallucis longus transfer is indicated if the tendon gap is more than 5 cm. We describe an endoscopic assisted flexor hallucis longus transfer in order to minimize the soft tissue dissection.