The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
May 5, 2026 · via Europe PMC
Isolated endoscopic flexor hallucis longus transfer versus open primary repair for Acute Achilles tendon ruptures: a retrospective comparative study.
Ucan V, Sulak B, Erdem AC, Toprak A, Uzer G, Elmali N.
AI summary — for doctors, generated from the abstract only
In a retrospective comparison for acute Achilles tendon rupture, endoscopic flexor hallucis longus tendon transfer achieved similar functional outcomes to open primary repair but with a substantially lower complication rate.
What was studied
A retrospective comparative study of 54 patients with acute Achilles tendon rupture treated surgically within 7 days of injury (2023-2024), comparing open primary repair (Krackow technique, n=32) versus isolated endoscopic flexor hallucis longus (FHL) tendon transfer (n=22), assessing functional scores (ATRS, AOFAS, VAS pain), return to activity, and complications.
Key findings
- No statistically significant differences were found between groups in functional outcome scores or time to return to activity.
- The overall complication rate was significantly higher with open repair than with endoscopic FHL transfer (28.1% vs. 4.5%, p = 0.03), mainly due to wound-related complications.
- Hallux (big toe)-related complaints in the FHL transfer group did not affect patients' daily activities.
Clinical relevance
The findings suggest that endoscopic FHL tendon transfer may be a viable alternative to open repair for selected acute Achilles tendon ruptures, offering comparable function with meaningfully fewer wound-related complications, which could inform surgical technique selection for this injury.
Who should care
Limitations
Small, retrospective, non-randomized comparative study (54 patients total) with surgeon- or case-based (not randomized) selection of technique, which could introduce selection bias; longer-term outcomes beyond the study period are not addressed in the abstract.
Endoscopic FHL tendon transfer for acute Achilles rupture achieved similar function to open repair but with a substantially lower complication rate (4.5% vs. 28.1%) in this retrospective comparison.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
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.
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.
DOI
10.1053/j.jfas.2026.05.003
PMID
42097445
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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