3rd Edition of Global Conference on Surgery and Anesthesia

September 14-15, 2022 | Online Event

September 14 -15, 2022 | Online Event
GCSA 2019

Value of pre-operative imaging of the flexor hallucis longus for achilles tendon transfer surgery

Abdus Samee Wasim, Speaker at Surgery Conferences 2022
Birmingham Orthopaedic Training Programme, United Kingdom
Title : Value of pre-operative imaging of the flexor hallucis longus for achilles tendon transfer surgery

Abstract:

Introduction: Flexor hallucis longus (FHL) tendon transfer is the method of choice in reconstructing chronic neglected Achilles tendon rupture (ATR). In routine FHL tendon transfer surgery, the FHL is excised at the level of the Master knot of Henry and transferred into a bone tunnel in the calcaneus bone. Using this technique, only the distal FHL tendon is visualised and abnormalities of the FHL muscle belly and proximal tendon may be missed.

Method: In our institution, a tertiary orthopaedic referral centre, we have encountered a varied spectrum of abnormalities involving the FHL on MRI and therefore, the FHL is an important review area for the musculoskeletal radiologist. We decided to specifically analyse fatty infiltration of the FHL and performed a retrospective review of 225 consecutive MR images of ankle performed at our institution during 2017 for ankle pain and analysed the extent of fatty infiltration of the FHL muscle using a modified Goutallier classification.

Results: We performed a retrospective review of 225 consecutive MR images of ankle performed at our institution during 2017 for ankle pain and analysed the extent of fatty infiltration of the FHL muscle using a modified Goutallier classification. The average age of the cohort was of the cohort was 44 years (10-82 years) with a female predominance (130 female and 95 males). 44% of the cohort had normal FHL, 42.7% demonstrated grade 1 fatty atrophy and further small proportion of patients with grade 2 (8.4%), grade 3 (3.1%) and grade 4 (1.8%) fatty atrophy.

Conclusion: Preoperative radiological assessment of the FHL tendon is important to establish that the FHL muscle and tendon are normal and intact and hence suitable for transfer surgery. The FHL is an important review area for the musculoskeletal radiologist and operating surgeon. With our findings, we can also hypothesise that fatty infiltration is a common finding in the FHL muscle. We suggest cross sectional imaging to assess the muscle belly prior to tendon transfer surgery for chronic ATR.

Biography:

Mr Wasim studied sciences at the Queen Elizabeth’s School London, United Kingdom developing an appetite for surgery at an early stage. He continued at Bart’s & the London School of Medicine, the oldest medical school in the world, graduating in 2014 with an MBBS (distinction) and BSc (Hons) in experimental pathology carrying out research at the Blizard Institute, London. He completed junior surgical training in Birmingham, achieving MRCS (England) and secured a trauma & orthopaedic specialty job on the prestigious Birmingham orthopaedic training programme. He has a keen interest in research and surgical education delivering multiple UK national training courses.

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