Functional Outcome of Flexor Hallucis Longus Tendon Grafting in Late Presenting Tendo Achilles Tear at a Tertiary Care Hospital of Nepal

Abstract

Introduction
Flexor hallucis longus (FHL) tendon augmentation in late presenting Tendo Achilles (TA) tear gives good patient satisfaction. This study aims to analyze the functional outcome of FHL use in TA tear in our setting.

Methods
A retrospective observational study was conducted at National Trauma Center, Nepal of all the cases of FHL use in TA tears during the last one year. The data were collected from the hospital records and functional outcome assessed at the follow up visit of 6 months. Statistical analyses were performed using SPSS 24. The central tendency was represented with median with Interquartile range (IQR) and mean and standard deviation(SD) were used. To compare the means and median, paired t-test and Wilcoxon ranked-sum test were used, respectively. The p-value less than 0.05 was considered statistically significant. 

Results
Total 30 cases were included in the study. The mean age was 52.27 + 5.32 years. The mean duration to surgery from injury was 9.53 + 4.13 weeks. The mean tear gap preoperatively was 3.02 + 0.69 cm, which after debridement increased to 3.88 + 0.45 cm. The median total AOFOS score preoperative was 48 (IQR 10)which increased to 82(IQR 3), which was statistically significant, p <0.001. Post-operatively, 29(96.67%) cases had good and 1(3.33%) case had excellent outcome. The most common complaints of the patient were pain post-operatively in 22(73.33%) cases, followed by ankle weakness in 19 (63.33%) cases.

Conclusion
The flexor hallucis longus tendon augmentation in late presenting Tendo Achilles tear gives good functional outcome. But most patients complained of pain and weakness post-operatively.