Endoscopic versus open flexor hallucis longus tendon transfer for reconstruction of chronic achilles tendon rupture: A prospective randomized pilot trial.

BACKGROUND

Chronic Achilles tendon rupture often requires surgical reconstruction. Flexor hallucis longus (FHL) tendon transfer is widely used, and endoscopic techniques may reduce soft-tissue morbidity and facilitate early recovery.

METHODS

Thirty patients with chronic Achilles tendon rupture were randomized to undergo open or endoscopic FHL tendon transfer. Functional outcome was assessed using the Foot and Ankle Ability Measure (FAAM) over 18 months. Secondary outcomes included operative time and wound complications. Exploratory outcomes included postoperative pain assessed by visual analog scale (VAS), duration of analgesic use, and time to return to work.

RESULTS

FAAM scores improved significantly in both groups over time (P < .001), with no significant difference between techniques at final follow-up (P = .487). Operative time was significantly longer in the endoscopic group (P < .001). Wound complications occurred only in the open group, affecting 5 of 15 patients (33.3%). Endoscopic reconstruction was associated with shorter duration of analgesic use (P = .007) and earlier return to work (P = .013). VAS pain scores decreased significantly in both groups with no significant between-group differences.

CONCLUSIONS

Both open and endoscopic FHL tendon transfer provided excellent functional outcomes in the management of chronic Achilles tendon rupture. The endoscopic technique was associated with fewer wound complications and improved early postoperative recovery, despite longer operative time.

LEVEL OF EVIDENCE: Level II, randomized controlled trial (pilot).