Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 9 , ISSUE 1 ( January-March, 2022 ) > List of Articles

Original Article

Functional Outcomes of Gastrocnemius Fascial Turn-down Flap with FHL Augmentation in Chronic Achilles Tear: A Short-term Prospective Study

Pradeep K Meena, Nagaraj Manju Moger, J Pragadeeshwaran, Sukhmin Singh

Keywords : Foot and ankle ability measure, Foot and ankle disability index, RUPP score, Tendo-Achilles, Visual analog scale

Citation Information : Meena PK, Moger NM, Pragadeeshwaran J, Singh S. Functional Outcomes of Gastrocnemius Fascial Turn-down Flap with FHL Augmentation in Chronic Achilles Tear: A Short-term Prospective Study. J Foot Ankle Surg Asia-Pacific 2022; 9 (1):16-20.

DOI: 10.5005/jp-journals-10040-1201

License: CC BY-NC 4.0

Published Online: 31-12-2021

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: Tendo-Achilles (TA) is one of the main tendons utilized for every movement of the lower limb. Rupture of TA leads to severe disruption of overall mobility and leads to difficulty in doing daily routine activities. The purpose of this prospective study was to observe the functional outcome of gastrocnemius fascial turn down flap with flexor hallucis longus (FHL) augmentation for chronic TA tear. Materials and methods: Tendo-Achilles rupture was diagnosed in all patients either by clinical or radiological means (most of them were type II or type III according to KUWADA classification). Preoperative functional scores (modified RUPP, FADI, FAAM, VAS) were documented. All 13 patients were treated surgically by gastrocnemius fascial turn down flap with FHL augmentation. All surgeries were performed by the same surgeon. The standard postoperative protocol was followed in all patients. Patients were followed up regularly at 3 months, 6 months, 1 year, and 2 years postoperative for functional outcome score. Results: The results were statistically analyzed by paired T-test for evaluating improvement in pre- and post-intervention periods. Functional outcome scores showed a significant improvement with FAAM score was improved from 30.84 ± 2.9 to 76.23 ± 3.98 (p < 0.001), FADI 40.92 ± 3.15 to 85.2 ± 4.04 (p < 0.001), modified RUPP score at 2 weeks postoperatively was 3.07 ± 1.18 which at 2 years of follow-up improved to mean score 22.77 ± 3.45 (p < 0.0001). VAS preoperatively value of 7.77 ± 1.01 improvised to 1.85 ± 0.99 at 2 years’ follow-up (p < 0.01) showing a significant decrease in overall pain. Conclusion: Functional outcomes show turn down flap with FHL augmentation as a good procedure for chronic TA rupture. Proper rehabilitation and wound care is the mainstay for good outcomes. Wound dehiscence is, however, a challenge that needs special care for providing good outcomes. Level of evidence: III


PDF Share
  1. Gabel S, Mandi A. Foot fellow's review neglected rupture of the achilles tendon,. Foot Ankle Int 1994(9):512–517. DOI: 10.1177/107110079401500912.
  2. Kumar DKS, Babu R, Shaik T, et al. Merits and demerits of different surgical techniques in treating old, neglected ruptures of tendo achilles. Int J Orthop Sci 2018;4(1c):190–194. DOI: 10.22271/ortho.2018.v4.i1c.30.
  3. Paavola M, Kannus P, Paakkala T, et al. Long-term prognosis of patients with achilles tendinopathy: an observational 8-year follow-up study. Am J Sports Med 2000;28(5):634–642. DOI: 10.1177/03635465000280050301.
  4. Jung HG. Foot and ankle disorders: an illustrated reference. Foot Ankle Disord An Illus Ref 2016;28(1):1–630. DOI: 10.1007/978-3-642- 54493-4.
  5. Willits K, Amendola A, Bryant D, et al. Operative versus nonoperative treatment of acute achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Jt Surg - Ser A 2010;92(17):2767–2775. DOI: 10.2106/JBJS.I. 01401.
  6. Carmont MR, Heaver C, Pradhan A, et al. Surgical repair of the ruptured achilles tendon: the cost-effectiveness of open versus percutaneous repair. Knee Surgery, Sport Traumatol Arthrosc 2013;21(6):1361–1368. DOI: 10.1007/s00167-013-2423-1.
  7. Chana JS, Chen HC, Jain V. A new incision for surgery on tendo Achillis using a distally-based fasciocutaneous flap. J Bone Jt Surg - Ser B 2002;84(8):1142–1144. DOI: 10.1302/0301-620X.84B8.13405.
  8. Čretnik A, Kosanović M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study. Am J Sports Med 2005;33(9):1369–1379. DOI: 10.1177/0363546504271501.
  9. Dalton GP, Wapner KL, Hecht PJ. Complications of Achilles and posterior tibial tendon surgeries. Clin Orthop Relat Res 2001;391(391):133–139. DOI: 10.1097/00003086-200110000- 00014.
  10. Ebinesan AD, Sarai BS, Walley GD, et al. Conservative, open or percutaneous repair for acute rupture of the Achilles tendon. Disabil Rehabil 2008;30(20–22):1721–1725. DOI: 10.1080/09638280701786815.
  11. Jiang N, Wang B, Chen A, et al. Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop 2012;36(4):765–773. DOI: 10.1007/s00264-011-1431-3.
  12. Aibinder WR, Patel A, Arnouk J, et al. The rate of sural nerve violation using the achillon device: a cadaveric study. Foot Ankle Int 2013;34(6):870–875. DOI: 10.1177/1071100712473097.
  13. Bradley JP, Tibone JE. Percutaneous and open surgical repairs of Achilles tendon ruptures: a comparative study. Am J Sports Med 1990;18(2):188–195. DOI: 10.1177/036354659001800213.
  14. Distefano V. Ruptures of the achilles tendon. Athl Train 1975;10(4):195–198.
  15. Spennacchio P, Vascellari A, Cucchi D, et al. Outcome evaluation after Achilles tendon ruptures. A review of the literature. Joints 2016;4(1):52–61. DOI: 10.11138/jts/2016.4.1.052.
  16. Martin RL, Irrgang JJ, Burdett RG, et al. Evidence of validity for the foot and ankle ability measure (FAAM). Foot Ankle Int 2005;26(11):968–983. DOI: 10.1177/107110070502601113.
  17. Hale SA, Hertel J. Reliability and sensitivity of the foot and ankle disability index in subjects with chronic ankle instability. J Athl Train 2005;40(1):35.
  18. Delgado DA, Lambert BS, Boutris N, et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev 2018;2(3):e088. DOI: 10.5435/JAAOSGlobal-D-17-00088.
  19. Kerkhoffs GMMJ, Struijs PAA, Raaymakers ELFB, et al. Functional treatment after surgical repair of acute Achilles tendon rupture: wrap vs walking cast. Arch Orthop Trauma Surg 2002;122(2):102–105. DOI: 10.1007/s004020100312.
  20. Baindoor P, Gumaste A, Jeevannavar S, et al. Full thickness open tear of the tendoachilles - functional outcomes following a stable, single stage repair. J Clin Orthop Trauma 2021;14(January 2012):132–138. DOI: 10.1016/j.jcot.2020.06.033.
  21. Koh D, Lim J, Chen JY, et al. Flexor hallucis longus transfer versus turndown flaps augmented with flexor hallucis longus transfer in the repair of chronic Achilles tendon rupture. Foot and Ankle Surgery 2019;25(2):221–225. DOI: 10.1016/j.fas.2017.10.019.
  22. Ozer H, Ergisi Y, Harput G, et al. Short-term results of flexor hallucis longus transfer in delayed and neglected Achilles tendon repair. J Foot Ankle Surg 2018;57(5):1042–1047. DOI: 10.1053/j.jfas.2018.03.005.
  23. Lever CJ, Bosman HA, Robinson AHN. The functional and dynamometer-tested results of transtendinous flexor hallucis longus transfer for neglected ruptures of the Achilles tendon at six years’ follow-up. Bone Jt J 2018;100-B(5):584–589. DOI: 10.1302/0301-620X.100B5.BJJ-2017-1053.R1.
  24. El-Tantawy A, Azzam W. Flexor hallucis longus tendon transfer in the reconstruction of extensive insertional Achilles tendinopathy in elderly: an improved technique. Eur J Orthop Surg Traumatol 2015;25(3):583–590. DOI: 10.1007/s00590-014-1569-y.
  25. Sharma S. The AOFAS clinical rating systems—time to bid adieu? J Foot Ankle Surg (Asia Pacific) 2019;6(1):1–1. DOI: 10.5005/jp-journals-10040-1103.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.