RESUMO
Objective To evaluate the effectiveness of flexor hallucis longus tendon transfer in treatment of chronic Achilles tendinopathy using different technique.Methods Sixty-four embalmed feet of 32 cadavers were analyzed and classified anatomically with respect to the individual cross links in the Henry's knot.These three techniques were then combined to determine the total potential tendon graft length obtainable using single incision,double incision and minimally invasive incision.From January,2012 to June,2015,10 patients (10 feet) with chronic Achilles tendinopathy were treated with double incision technique.The score was 63.04 ±7.75 according to American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system.Results Only two different configurations were found.Type 1,a tendinous slip branched from the FHLT to the FDLT was 96.9％(62 of 64 feet).Type 2,a slip branched from the FHLT to the FDLT and another slip from the FDLT to FHLT was 3.1％(2 of 64).The average length of the FHLT graft available from a single incision measured (5.08±1.09)cm,double incision technique measured (6.72 ± 1.02) cm,and minimally invasive incision measured (17.49 ± 1.80)cm.The difference between the lengths obtained from these three techniques was statistically significant.Ten patients were followed-up 12-36 months (mean,13.7 months).At 12 months after operation,the AOFAS ankle and hindfoot score was 93.28 ± 3.72,showing significant difference when compared with that before operation.The results were excellent in 6 cases,good in 3 cases,and fair in 1 case with an excellent and good rate of 90％.No sural nerve injury,posterior tibial nerve injury,medial plantar nerve injury,and lateral plantar nerve injury occurred.Conclusion In over 96 ％ of the feet,a proximal to distal connection from the FHLT to the FDLT was found,which might contribute to the residual function of the lesser toes after FDLT transfer.The distal stump of the FHLT tendon should be sutured onto the FDLT tendon under tension to en able a co-activation of the great toe,preserved hallux plantar flexion.Chronic Achilles tendinopathy reconstruction with flexor hallucis longus tendon harvested using double incision technique offers a desirable outcome in operative recovery,tendon fixation,preserved hallux plantar flexion and less complications.
RESUMO
<p><b>OBJECTIVE</b>To explore the method of the treatment for hallux valgus with the proximal crescentic osteotomy of the first metatarsal bone, combining with distal lateral soft tissue release.</p><p><b>METHODS</b>From January 2008 to December 2012, 21 cases 21 hallux valgus feet were treated by operative procedure, included 1 male (1 foot) and 20 females (20 feet), with the mean age of 52 years (range, 36-68 years). Among all patients were followed up for 12 to 26 months, with the mean 16 months. The preoperative, post-operative and final follow-up X-ray films of all patients were collected. The hallux valgus angle, intermetatarsal angle and distal metatarsal articular angle were measured and analyzed. The surgical outcome was evaluated combined with the AOFAS score.</p><p><b>RESULTS</b>The average hallux valgus angle decreased from 42.3° ± 1.8° preoperatively to 14.5° ± 1.8 postoperatively, the average intermetatarsal angle did from 21.9° ± 1.7 to 9.1° ± 1.8°, and the average distal metatarsal articular angle did from 14.9° ± 1.8 to 7.2° ± 1.5, respectively. There were significant differences between the preoperative and postoperative roentgenographic index. AOFAS score was improved from 44.0 ± 1.8 preoperatively to 83.9 ± 2.2 at the final follow-up.</p><p><b>CONCLUSIONS</b>The proximal crescentic osteotomy of the first metatarsal bone combined distal soft tissue reconstruction obtained satisfactory results in severe hallux valgus patients with big intermetatarsal angle.</p>