Background. Complete rupture of the flexor hallucis longus tendon in an isolated closed injury is a rare event. The infrequent identification of this injury may be due to a low clinical suspicion of the flexor hallucis longus tendon being a source of pathology in closed foot and ankle injuries. This review will assess the current body of literature and analyse the clinical presentation and current concepts in management of this specific pattern of tendon injury.
Method. A systematic literature search was conducted in MEDLINE and Embase to identify relevant publications. Two separate researchers independently reviewed the references identified in the literature search, with each article being assessed against published selection criteria specified in the study protocol registered with PROSPERO. Two reviewers individually examined the raw data presented in each paper that met final inclusion criteria. This data was then presented in the final analysis.
Results. There were 10 documented case reports of complete rupture of the flexor hallucis longus tendon in an isolated closed injury reported in the literature. The majority of subjects were male (70%), with an average age of 38 years. The duration of prodromal symptoms ranged from 0-8 months. The most common mechanism of injury was running, seen in 30% of cases. Every documented case in the literature underwent surgical management. Common post-operative outcomes reported were individual joint range of motion and return to prior level of physical activity.
Conclusion. Due to the occult nature of the injury and synergistic function of other structures in the foot, delayed presentation of closed flexor hallucis tendon rupture is common. It is unclear from the current body of literature if surgical management of this injury significantly improves patient outcomes. Current evidence from the management of open flexor hallucis longus tendon ruptures suggests that patients can achieve good functional outcomes with non-operative management. Our recommendation would be for initial non-operative treatment of closed flexor hallucis longus tendon ruptures given the potential for acceptable functional outcomes, and to avoid the potential complications associated with operative repair.
Complete rupture of the flexor hallucis longus tendon in an isolated closed injury. A systematic literature and qualitative analysis
D.L. Kerr, S. Butler, K. Thompson, A. Higgs
Original Article, 105 - 111
Keywords: closed injury, complete rupture, FHL, flexor hallucis longus, tendon rupture non-operative,
Table of Content: Vol.9 (No.1) 2019 January/March
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M.L.T.J. – Muscle, Ligaments and Tendons Journal: 2019 The way forward
N. MaffulliEditorial, 1 -
Short term evaluation of the hamstring graft diameter after ACL reconstruction
D. Costa Astur, D. Pires, T. Parente, P. Debieux, C. Cohen Kaleka, A. Skaf, M. CohenOriginal Article, 3 - 7 -
The efficacy of bi-component carboxymethylcellulose-polysaccharide B as a hemostatic and anti-adherent agent at the tibial insertion of the hamstring tendons after reconstruction of the anterior cruciate ligament
D. Costa Astur, F. Caracatto Baras, R. Moukbel Chaim, J. J. Krob, G. Gonçalves Arliani, G. Taniguti de Oliveira, M. CohenOriginal Article, 8 -13 -
Multi-ligament injures of the knee: does the age matter? A long-term retrospective study
N. Zimmermann, L.B. Moser, M.T. HirschmannOriginal Article, 14 -20 -
The use of robotics devices in knee rehabilitation: a critical review
R. Wilmart, E. Garone, B. InnocentiOriginal Article, 21 - 48 -
Iliotibial band syndrome: can the lateral femoral epicondyle play a role? An anatomic study of individual variation in epicondyle prominence
J.S. Everhart, A. Di Bartola, A.M.W. Chaudhari, D.C. FlaniganOriginal Article, 49 - 54 -
Anterior cruciate ligament deficiency: rotational instability in the transverse plane. A preliminary laboratory in vivo study
A. Ferrer, R. Twycross-Lewis, N. MaffulliOriginal Article, 55 -61 -
Gait disturbances in football, rugby players and skiers following anterior cruciate ligament reconstruction
M.C. Zielinski, R. Twycross Lewis, R. Woledge, N. MaffulliOriginal Article, 62 - 69 -
ACL biomechanical risk factors on single-leg drop-jump: a cohort study comparing football players with and without history of lower limb injury
S. Daoukas, N. Malliaropoulos, N. MaffulliOriginal Article, 70 - 75 -
Posterior meniscal root repair: a biomechanical comparison between human and porcine menisci
L. Camarda, E. Bologna, D. Pavan, F. Morello, F. Monachino, F. Giacco, M. ZingalesOriginal Article, 76 - 81 -
Return to play after anterior cruciate ligament reconstruction: trans-tibial versus antero-medial technique
A. Tucciarone, L. Godente, F. Netti, F. Martinelli, R. Fabbrini,L. Del Ferraro, R. D’OnofrioOriginal Article, 82 - 89 -
Ultrasonography changes at quadriceps tendon donor site in anterior cruciate ligament reconstruction. Is it consistent with regeneration?
D. Nalla, S. Kumar Nema, D. Barathi, G. BalajiOriginal Article, 89 - 94 -
Vascular structures and relationship to intramuscular fat in supraspinatus muscle following tendon detachment and reattachment – an experimental study in rabbits
M. MacIntyre-Newell, H.K. Uhthoff, G. Trudel, O. LaneuvilleOriginal Article, 95 - 104 -
Complete rupture of the flexor hallucis longus tendon in an isolated closed injury. A systematic literature and qualitative analysis
D.L. Kerr, S. Butler, K. Thompson, A. HiggsOriginal Article, 105 - 111 -
Platelet-rich plasma in hamstring muscle injuries in professional soccer players. A pilot study
E. Bezuglov, N. Maffulli, A. Tokareva, E. AchkasovOriginal Article, 112 - 118 -
Morphological variants of nerve to gastrocnemius muscle, an anatomical guide to perform surgical dissection
V. Prathapamchandra, L. V. Prabhu, M. M. Pai, B.V. Murlimanju, R. VadgaonkarOriginal Article, 119 - 123 -
Usefulness of point shear wave elastography to assess the effects of extracorporeal shockwaves on spastic muscles in children with cerebral palsy: an uncontrolled experimental study
B. Corrado, M. Albano, M.G. Caprio, C. Di Luise, M. Sansone, V. Servodidio, S. Russo, G. Vallone, E.A. Vola, C. Servodio IammarroneOriginal Article, 124 - 130 -
A morphometric study of the popliteus myotendinous complex with its clinical aspects
P. C. Vani, V. RaveendranathOriginal Article, 131 - 137 -
Efficacy of triamcinolone injection with or without oral meloxicam for treatment of anserine syndrome: a randomized, double-blind, placebo controlled trial
S. Thiengwittayaporn, S. Phatwong, N. Kangkano, N. CharoenphandhuOriginal Article, 138 - 144 -
Correlation of Handgrip Strength to Postoperative Outcomes in Rotator Cuff Repair: A Preliminary Report
Y. Karanjkar, A. Prabhu, K. VishalOriginal Article, 145 - 149 -
Combined anatomic reconstruction of the anterior cruciate and anterolateral ligaments
N. Maffulli, F. Oliva, A. OlivieroOriginal Article, 150-155