This Level I RCT asked whether adding FHL tendon transfer to Achilles debridement improves outcomes in patients over 50 with chronic insertional Achilles tendinopathy. Patients were randomized to debridement alone or debridement plus FHL transfer, with blinded outcome assessment at up to 1 year.
Case series of FHL transfer for insertional Achilles tendinopathy in older patients showed encouraging results, and many surgeons adopted it routinely for patients over 50. No Level I evidence existed to support or refute this practice before this trial.
For a patient over 50 presenting for primary surgical treatment of insertional Achilles tendinopathy, debridement and partial calcaneal ostectomy alone produces equivalent pain relief, functional scores, and satisfaction compared with adding FHL transfer. The extra dissection is not justified for routine primary cases.
Reserve FHL augmentation for revision cases or situations where substantial tendon must be excised, where the strength benefit may matter more. Counsel patients that minor wound complications occur in roughly 1 in 3 cases regardless of technique, and that overall satisfaction at 1 year is approximately 87%.
This Level I RCT asked whether adding FHL tendon transfer to Achilles debridement improves outcomes in patients over 50 with chronic insertional Achilles tendinopathy. Patients were randomized to debridement alone or debridement plus FHL transfer, with blinded outcome assessment at up to 1 year.
Case series of FHL transfer for insertional Achilles tendinopathy in older patients showed encouraging results, and many surgeons adopted it routinely for patients over 50. No Level I evidence existed to support or refute this practice before this trial.
For a patient over 50 presenting for primary surgical treatment of insertional Achilles tendinopathy, debridement and partial calcaneal ostectomy alone produces equivalent pain relief, functional scores, and satisfaction compared with adding FHL transfer. The extra dissection is not justified for routine primary cases.
Reserve FHL augmentation for revision cases or situations where substantial tendon must be excised, where the strength benefit may matter more. Counsel patients that minor wound complications occur in roughly 1 in 3 cases regardless of technique, and that overall satisfaction at 1 year is approximately 87%.