Comparative study of flexor hallucis longus vs. peroneus brevis tendon transfer for chronic Achilles rupture

Background: The Achilles tendon (TA) is the human body's strongest tendon, and it ruptures most frequently in the lower extremities. Various reconstructive techniques, such as flexor hallucis longus (FHL) tendon transfer and peroneus brevis (PB) transfer, each have advantages and disadvantages. The purpose of this study was to compare the results of FHL tendon transfer with an interference screw with PB transfer for late Achilles tendon rupture at NITOR. Methodology: A quasi-experimental study was conducted at NITOR from September 2021 to March 2024, involving 30 patients (15 per group) with clinically confirmed late Achilles tendon rupture. The clinical results and the AOFAS score were used for evaluation. Results: The mean age was 40.03 ± 7.56 years, with a male predominance (80 %) and right-sided injuries (53 %). The majority (67 %) of ruptures were accidental. The mean duration from rupture to surgery was 21.33 ± 5.47 days, and the mean hospital stay was 18.5 ± 3.92 days. At follow-up, 67 % in the FHL group and 60 % in the PB group reported no pain. Activity limitations were absent in 93 % of the FHL group and 87 % of the PB group. Both groups had 100 % no gait abnormalities, with 93 % having normal or mildly restricted hindfoot motion. The FHL group showed 87 % good alignment, while the PB group had 80 %. Complications were fewer in the FHL group (80 % with no complications) compared to the PB group (67 %). The FHL group had a mean AOFAS score of 90.73 ± 3.97 and the PB group 87.87 ± 5.73, with no significant difference (p = 0.9635). Conclusion: There was no significant difference between FHL and PB transfer for late Achilles tendon rupture. However, the FHL transfer had fewer complications compared to the PB transfer.