Isolated endoscopic flexor hallucis longus transfer versus open primary repair for Acute Achilles tendon ruptures: a retrospective comparative study
JOURNAL OF FOOT & ANKLE SURGERY, vol.65, no.5, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 65 Issue: 5
- Publication Date: 2026
- Doi Number: 10.1053/j.jfas.2026.05.003
- Journal Name: JOURNAL OF FOOT & ANKLE SURGERY
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Istanbul University Affiliated: No
Abstract
Background: Open primary repair is widely used for acute Achilles tendon rupture but is associated with woundrelated complications. Endoscopic flexor hallucis longus (FHL) transfer has been proposed as an alternative strategy to reduce soft-tissue morbidity. Purpose: To compare clinical outcomes and complication rates between open primary repair and isolated endoscopic FHL transfer in acute Achilles tendon ruptures. Methods: Patients who underwent surgical treatment within 7 days of injury between 2023 and 2024 were retrospectively reviewed. All ruptures involved the watershed region. Patients underwent either open primary repair using a Krackow technique or isolated endoscopic FHL transfer. Outcomes included ATRS, AOFAS score, VAS pain score, return to activity, and complications. Results: Fifty-four patients were included (32 open, 22 FHL). No statistically significant differences were detected between groups in functional outcome scores or return-to-activity times. The overall complication rate was significantly higher in the open repair group compared with the FHL group (28.1% vs 4.5%, p = 0.03), mainly due to wound-related complications. Hallux-related complaints did not affect daily activities in the FHL group. Conclusion: Isolated endoscopic FHL transfer was associated with similar functional outcome scores and a lower complication rate compared with open repair. This technique may represent a potential alternative in selected acute Achilles tendon ruptures. (c) 2026 by the American College of Foot and Ankle Surgeons. All rights are reserved, including those for text and data mining, AI training, and similar technologies.