Percutaneous repair of acute Achilles tendon tears with minimally invasive augmentation with the tendon of flexor hallucis longus: a 5 years outcome study.

BACKGROUND

Even after surgical repair, acute Achilles tendon rupture (ATR) may leave residual strength and function deficits. Augmenting percutaneous repair with the flexor hallucis longus (FHL) tendon may limit elongation and reinforce the repair. We report 5-year outcomes of acute ATR managed with percutaneous repair alone or with minimally invasive FHL augmentation.

SOURCES OF DATA: A prospective comparative cohort of 53 patients (27 percutaneous repair alone, 26 with FHL augmentation) with a minimum 5 years follow-up. Objective and subjective outcomes were collected.

AREAS OF AGREEMENT: At 5 years, both procedures gave equivalent results on all patient-reported outcome measures. FHL augmentation reduced tendon elongation (lower Achilles tendon Resting Angle) and produced statistically significantly greater isometric strength and smaller calf circumference difference.

AREAS OF CONTROVERSY: Structural and strength differences were small, of doubtful clinical relevance, and did not improve patient-reported function. FHL augmentation is more demanding, longer, costlier, and required inpatient admission, whereas percutaneous repair was a day-case procedure under local anesthesia. A significant between-group age difference is an important confounder.

GROWING POINTS: Structural indices frequently dissociate from patient-reported function after ATR. Within the Italian National Health Service, the added resource use of FHL augmentation is hard to justify when no validated measure detects a clinically meaningful 5-year difference.

AREAS TIMELY FOR DEVELOPING RESEARCH: Adequately powered randomized trials with pre-specified age stratification are needed to establish whether particular subgroups, such as older patients or those with more degenerate tendons, derive a clinically relevant benefit from FHL augmentation.