Reconstruction of chronic Achilles tendon ruptures in elderly patients, with vascularized Flexor Hallucis Longus (FHL) tendon transfer using single incision technique.

Purpose: To report the outcome following reconstruction of neglected Achilles tendon ruptures in elderly patients with Flexor hallucis longus tendon (FHL) biotenodesis.Method: Seventeen cases (mean age 65.7 years), of Achilles tendon reconstruction with FHL biotenodesis for chronic ruptures were reviewed. Outcomes evaluated with American orthopaedic foot and ankle score (AOFAS), calf girth atrophy, range of ankle movement, ability to perform single leg heel raise and patient satisfaction.Results: The mean follow up was 27 months (range 17-52). The mean AOFAS score improved from 57.47 (+/-5.98) to 96.71(+/-3.57). Mean calf girth atrophy was 1.53 (+/- 0.43 cm) on the operated side. There was no significant difference in the range of ankle movement. All except one patient were able to perform single leg heel raise. We observed an inverse relation for patient age and chronicity of tear to the endurance strength of Achilles tendon. All the patients were satisfied with the outcome. We had one complication of superficial wound infection.Conclusion: Single incision FHL biotenodesis is a safe and effective procedure for this complex condition. It mitigates the need for extensive soft tissue procedures like turn down flaps or V-Y plasty.