Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture

Abstract

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are e ective methods for Achilles tendon contracture. is study aims to evaluate the e cacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-ve cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. e function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. e mean follow-up period was 42.04 months in group A and 61.7 months in group B. e entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. e infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at nal follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modi ed surgery can signi cantly reduce the risk of Achilles tendon rupture, provide better balance in so tissue strength between ankle dorsi exion and ankle plantar exion, helping to avoid recurrence of the deformity.