METHOD FOR ENDOSCOPIC TRANSPOSITION OF FLEXOR HALLUCIS LONGUS MUSCLE TENDON ON CALCANEAL TUBEROSITY IN OLD RUPTURES OF ACHILLES TENDON Russian patent published in 2025 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology, orthopaedics and neurosurgery, and can be used for endoscopic transposition of tendon of flexor hallucis longus muscle on calcaneal tuberosity in old ruptures of Achilles tendon. Before performing the surgical treatment, MRI is used to visualize the chronic Achilles tendon ruptures, the presence of a diasthesis between the ends of the injured tendon; the state of the surrounding soft tissues, vascular and nerve structures is assessed. With the patient lying on his/her stomach, a posterolateral and then a posteromedial approach to the ankle joint is performed. Vertical paraachillary approach is performed with dissection of skin only, blunt separation of soft tissues. Trocar and the shaft for the arthroscope are inserted parallel to the plane of the sole and towards the head of the second metatarsal bone until it rests against the bone. Posteromedial paraachillary approach is performed, and the shaver is introduced under the Achilles tendon to visualize the canal of the tendon of flexor hallucis longus muscle and the Achilles tendon. Transverse inter-malleolar ligament is dissected and a tendon of a flexor hallucis longus muscle is mobilized. Tendon of a flexor hallucis longus muscle is fixed. Maximum tension is made and crossed. Tendon of the flexor hallucis longus muscle is brought out into the posteromedial port and sutured to length of 20 mm. Diameter of the long flexor muscle of the big toe is determined for the subsequent formation of canal 10-15 mm deeper than the sutured tendon of the flexor hallucis longus muscle, and the canal is formed through the posteromedial port with the addition of a paraachillary port to ensure accurate positioning of the canal. Pin is inserted to determine the vector of the canal, wherein the canal in the calcaneal bone is formed, respectively, of a certain diameter of a tendon of flexor hallucis longus muscle. Flexor hallucis longus muscle tendon is brought into the formed canal to the required depth in a foot position of 10° plantar flexion, while the tendon of the flexor hallucis longus muscle should be stretched. Tendon of a flexor hallucis longus muscle is fixed by means of a biodegradable tenodesis screw. Wound is washed and closed with aseptic dressings. Ankle joint is immobilized for 6 weeks, followed by a passive and gradual development of movements with gradual withdrawal of the foot into a neutral position, after which the patient is allowed to rest on the operated limb with constant wearing of a hinged orthosis for 2 weeks.

EFFECT: method provides reduced surgical aggression and reduced risk of infectious complications of soft tissues, reduced traumatisation of vascular and neural structures, exclusion of the probability of mechanical teething of the tendon in fixation of the tendon in the canal of the calcaneal bone, exclusion of the probability of fracture of the posterior wall of the canal of the calcaneal bone during its formation due to the peculiarities of the method implementation.

1 cl, 3 ex