Minimally Invasive Revision Surgery Combining Endoscopic Double-Row Reinsertion and Flexor Hallucis Longus Transfer for Insertional Achilles Tendon Re-Rupture in a Semi-Professional Rugby Player: A Case Report

Background/Objectives: Acute insertional Achilles tendon rupture (A-IATR) is a rare, often season-ending injury in athletes. Revision after a failed repair is particularly challenging, and return to sport (RTS) after such surgery is rarely documented. We report one such case.

Methods

A 32-year-old semi-professional rugby prop forward sustained an insertional re-rupture eighteen months after open transosseous reinsertion without suture anchors. MRI showed complete detachment with 15 mm of retraction and no residual tendon on the footprint. A single-stage procedure combining endoscopic double-row (SpeedBridge™) reinsertion and flexor hallucis longus (FHL) transfer was performed, followed by six weeks of non-weight-bearing cast immobilization and criteria-based rehabilitation, with Ankle-GO™-guided return to play.