Arthroscopic Flexor Hallucis Longus Transfer for Chronic Achilles Tendon Rupture

Achilles tendon (TA) rupture is a common sports injury. Often, delay in treatment or misdiagnosis result in neglected chronic TA rupture. Chronic TA rupture leads to weak plantar flexion of the foot and its management differs from acute ruptures. Flexor hallucis longus (FHL) transfer for chronic TA ruptures has been shown to yield good results as it is able to bridge the TA gap and complements the triceps surae in plantar flexion. However, there are associated wound complications with the open technique, especially in patients with risk factors such as steroid and tobacco use, older age, diabetic, and obesity. We report our experience in the arthroscopic FHL transfer technique, which is less invasive, avoids possible risks of wound complications associated with open technique, and potentially allows for earlier rehabilitation. We recommend this technique in all chronic TA ruptures, particularly in patients with comorbidities, which could result in postoperative wound infection.