Effect of Achilles Tendon Lengthening and Gastrocnemius Recession on Radiographic Tibiotalar Motion Following Total Ankle Replacement

Abstract

Background: Surgeons frequently add an Achilles tendon lengthening or gastrocnemius recession to increase dorsiflexion following total ankle replacement. Previous studies have looked at the effects of these procedures on total tibiopedal motion. However, tibiopedal motion includes motion of the midfoot and hindfoot as well as the ankle replacement. The current study examined the effects of Achilles tendon lengthening and gastrocnemius recession on radiographic tibiotalar motion at the level of the prosthesis only. Methods: Fifty-four patients with an average of 25 months follow-up after total ankle replacement were divided into 3 groups: (1) patients who underwent Achilles tendon lengthening, (2) patients who had a gastrocnemius recession, (3) patients with no lengthening procedure. Tibiotalar range of motion was measured on lateral dorsiflexion-plantarflexion radiographs using reference lines on the surface of the implants. Results: Both Achilles tendon lengthening and gastrocnemius recession significantly increased tibiotalar dorsiflexion when compared to the group without lengthening. However, the total tibiotalar range of motion among the 3 groups was the same. Interestingly, the Achilles tendon lengthening group lost 11.7 degrees of plantarflexion compared to the group without lengthening, which was significant. Conclusion: Both Achilles tendon lengthening and gastrocnemius recession increased radiographic tibiotalar dorsiflexion following arthroplasty. Achilles tendon lengthening had the unexpected effect of significantly decreasing plantarflexion. Gastrocnemius recession may be a better choice when faced with a tight ankle replacement because it increases dorsiflexion without a compensatory loss of plantarflexion. Level of Evidence: Level III, retrospective comparative study.

Tibiopedal Motion Following Tendo-Achilles Lengthening or Gastrocnemius Recession in Total Ankle Replacement: A Comparative Cohort Study

“…The study had the unexpected results of a statistically significant loss of 11.7 degrees of PF in the TAL group; however, preoperative ROM radiographs were only available in 27 of the 54 patients for comparison (TAL n=10, GR n=3, control n=14). 14 A few limitations of this study were the lack of preoperative ROM parameters (only 50% of patients) and clinical rather than radiographic ROM measurements. Our study results similarly confirmed a loss of PF in the TAL cohort; however, the same phenomena were true of the GR cohort.…”

“…However, as previously mentioned, tibiopedal motion includes motion of the midfoot and hindfoot as well as the ankle replacement. Jeng et al 14 examined the effects of TAL and GR on radiographic tibiotalar motion at the level of the prosthesis only. Fifty-four patients with an average of 25 months’ follow-up after TAR were divided into patients who underwent TAL, GR, or no lengthening procedure.…”

“…23,25 These procedures are not without risk as TAL may result in rupture of the Achilles tendon, whereas GR patients are at risk of losing strength in plantarflexion and nerve injury. 17,29 A comparative analysis of these procedures was performed by Jeng et al, 14 who evidenced that both TAL and GR resulted in an increase in DF, with only GR resulting in a simultaneous increase in PF. Additionally, Ruiz et al 23 reported that patients with high preoperative ROM experienced decreased ankle ROM at final follow-up (mean of 5 years), and that percutaneous TAL had no effect on ankle ROM after TAR.…”

Letter Regarding: Tibiopedal Motion Following Tendo-Achilles Lengthening or Gastrocnemius Recession in Total Ankle Replacement: A Comparative Cohort Study

“…Foot & Ankle International 44 (3) mostly. Of note, the greater PF loss for the GR group than the TAL group could not be explained by these speculations, and it warrants further study.…”

“…5 Additionally, under this assumption, the more PF loss in the GR group indicated more loss of push-off strength, which is not consistent with the authors’ previous study. 2 Besides, Jeng et al 3 conducted a similar study and obtained somewhat different results, with TAL exhibiting greater PF loss conversely. We reviewed the literature 1,2,3,5 and our institutional experience of TAR to attempt to explain this issue: (1) postoperative immobilization after heel cord lengthening tends to be more dorsiflexion to avoid recurrence of equinus deformity; (2) the majority of physiotherapy rehabilitation exercises focus on dorsiflexion, and it is easier for patients to passively force dorsiflexion by themselves than plantarflexion; and (3) the plantarflexion weakness leads to a chronic anterior ankle contracture over time.…”