Isolated endoscopic flexor hallucis longus transfer versus open primary repair for Acute Achilles tendon ruptures: a retrospective comparative study.

Abstract

Open primary repair is widely used for acute Achilles tendon rupture but is associated with wound-related complications. Endoscopic flexor hallucis longus (FHL) transfer has been proposed as an alternative strategy to reduce soft-tissue morbidity. To compare clinical outcomes and complication rates between open primary repair and isolated endoscopic FHL transfer in acute Achilles tendon ruptures. 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. 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. 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.