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Endoscopic flexor hallucis tenolysis combined with ACL reconstruction allows  better function and return to high sporting activities

Published in N°016 - March / April 2022
Article viewed 51 times

Endoscopic flexor hallucis tenolysis combined with ACL reconstruction allows better function and return to high sporting activities

By Theresa Olden, Jacques Vallotton in category BIOMECHANICS
Centre Orthopédique d’Ouchy, Lausanne, Suisse / [email protected] / [email protected]

Endoscopic tenolysis of the Flexor Hallucis Longus (FHL) tendon was associated with Anterior Cruciate Ligament (ACL) reconstruction in a series of 136 patients operated by the same surgeon between 2002 and 2019. The aim of this study is to evaluate the benefit to combine both procedures.

Introduction

Purpose

Endoscopic tenolysis of the Flexor Hallucis Longus (FHL) tendon was associated with Anterior Cruciate Ligament (ACL) reconstruction in a series of 136 patients operated by the same surgeon between 2002 and 2019. The aim of this study is to evaluate the benefit to combine both procedures. The study design is dual: there is a retrospective part, concerning the items “wellbeing” and “return to sport”, based on answers to our patient questionnaire, and a prospective part regarding the pre- and post-surgery footprint and gait analysis, recorded on our foot-scan platform.

ACL injury mechanisms and Functional Hallux Limitus (FHLim) implication

ACL tears occur mostly in non-contact injuries and more in women than men. The mechanism is a quick pivotal movement that leads by a “corkscrew” mechanism to a "medial collapse" of the knee into valgus and internal rotation [1,2]. We identified Functional Hallux Limitus (FHLim) as a kinematic condition involved in this process. Indeed, the "corkscrew" mechanism is related by inter-articular synchronism to an abrupt transition from foot supination into exaggerated pronation during the support phase of the human gait cycle. [3-5] As this pronation is synchronized with internal tibial rotation, the knee is pulled in a spiral...

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