Achilles Reconstruction :Flexor Hallucis Longus tendon transfer using Arthrex Biotenodesis screw
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The Flexor Hallucis Longus transfer for Achilles reconstruction is a straight-forward and effective operation for salvaging various situations which have resulted in a deficient and de-functioned Achilles tendon.
The flexor hallucis longus tendon is easily accessed sitting just anterior to the Achilles tendon and can be safely harvested as long as care is taken to identify and avoid the posterior tibial neuro-vascular bundle. It has not been my experience in performing this procedure for over 15 years that any more than a single incision is required to access and harvest adequate length of the FHL for reconstruction. If the tendon is slightly too short for a bone anchor it can be woven into the native Achilles insertion and sutured.
The Arthrex Biotenodesis screw is a useful implant to anchor the harvested tendon into the calcaneus, though the tendon can be woven into the native Achilles insertion also. The key is appropriate tensioning of the transfer.
Despite the slightly more involved nature of surgery compared to primary Achilles repair the period of immobilisation and recovery and outcome are little different.
Author:Mark Herron FRCS.
Institution: The Wellington Hospital, London, UK.
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Question 1 of 14
The indications for an FHL tendon transfer do not include which one of the following indications ?CorrectIncorrect
Question 2 of 14
After an Achilles rupture which one of the following is not true ?CorrectIncorrect
Question 3 of 14
On examining an Achilles rupture which one of the following is not true about the findings ?CorrectIncorrect
Question 4 of 14
Which one of the following is true of the investigation of a chronic Achilles rupture?CorrectIncorrect
Question 5 of 14
Which one of the following is true of the incision for an FHL transfer ?CorrectIncorrect
Question 6 of 14
Which one of the following is true of the location of the posterior Tibial nerve with respect to the operative approach described?CorrectIncorrect
Question 7 of 14
In mobilising enough FHL to transfer which of the the following steps will not be required?CorrectIncorrect
Question 8 of 14
To aid in harvest of the FHL tendon which one of the following is true ?CorrectIncorrect
Question 9 of 14
In anchoring the FHL transfer which one of the following statements is not correct ?CorrectIncorrect
Question 10 of 14
Which one of the following is correct of how to proceed If the bone tunnel/implant fixation fails ?CorrectIncorrect
Question 11 of 14
In tensioning the FHL transfer which one of the following statements is correct ?CorrectIncorrect
Question 12 of 14
During the post-operative phase which one of the following statements is correct ?CorrectIncorrect
Question 13 of 14
Which one of the following is not true of the reported outcomes after FHL transfer?CorrectIncorrect
Question 14 of 14
With respect to the published results which one of the following is true?CorrectIncorrect