Surgical outcomes of insertional Achilles tendinopathy: A comparison of techniques with and without FHL transfer
Journal of Foot and Ankle Surgery, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1053/j.jfas.2026.05.010
- Dergi Adı: Journal of Foot and Ankle Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Anahtar Kelimeler: 3,, Achilles insertional calcific tendinosis, case control study, Flexor hallucis longus, Haglund deformity, Insertional Achilles tendinopathy, Tendon disorders
- Gazi Üniversitesi Adresli: Evet
Özet
Background: Insertional Achilles tendinopathy may require surgery when nonoperative treatment fails. Flexor hallucis longus (FHL) tendon transfer is used as an adjunct in advanced insertional degeneration. Purpose: To compare 1-year outcomes, minimal clinically important difference (MCID) achievement, and complications between FHL transfer with debridement/retrocalcaneal ostectomy and debridement/ostectomy alone. Study design: Retrospective comparative cohort study (indication-based group allocation). Methods: Thirty consecutive patients treated surgically between 2017 and 2023 were reviewed retrospectively. Preoperative magnetic resonance imaging (MRI) planimetry guided selection: patients with >50% degeneration underwent FHL transfer plus debridement and retrocalcaneal ostectomy (n = 15), whereas patients with ≤50% degeneration underwent debridement and ostectomy alone (n = 15). Outcomes were assessed preoperatively and at 1 year using the Victorian Institute of Sport Assessment–Achilles (VISA-A), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AH), Foot and Ankle Ability Measure (FAAM), Foot and Ankle Disability Index (FADI), and visual analog scale (VAS) pain. MCID was calculated using a distribution-based method. Results: Both groups improved significantly at 1 year (all p < 0.05). No between-group differences were observed for VAS, AOFAS-AH, FAAM, or FADI (all p > 0.05). The FHL group had higher postoperative VISA-A scores (65.9 ± 15.3 vs 49.9 ± 19.7; p = 0.031) and higher VISA-A MCID achievement (93.3% vs 66.6%; p = 0.046). Minor wound complications occurred in 4 patients (2/15 in each group). Conclusions: Both surgical approaches improved pain and function at 1 year. In this indication-based cohort, adding FHL transfer for >50% MRI-defined degeneration was associated with higher Achilles-specific function (VISA-A) without increased wound complications.