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 effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy 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-five 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. The 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 The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The 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. The 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 final 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 Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.

Triple Hemisection Percutaneous Achilles Tendon Lengthening for Severe Ankle Joint Deformity

“…In the first surgical treatment of simple Achilles tendon contracture, satisfactory results have been achieved with the application of triple hemisection percutaneous Achilles tendon lengthening 10 , 11 . As a new technique, it has the following four characteristics.…”

“…The purpose of Achilles tendon lengthening is to improve the dorsiflexion of the ankle joint and correct the deformity. The study of Lin et al 10,11 showed that modified percutaneous Achilles tendon lengthening by triple hemisection was better compared with the traditional open Zlengthening in terms of operation time, tendon healing and incidence of complications. This is because percutaneous lengthening significantly improved.…”

“…In recent years, triple hemisection percutaneous Achilles tendon lengthening has achieved ideal results in the treatment of simple Achilles tendon contracture 10 , 11 . This technique bases on the percutaneous sliding technique with three hemi‐cuts in the tendon to achieve the effect of lengthening the Achilles tendon.…”

The use of Percutaneous Achilles’ Tendon Lengthening as an Adjunct Procedure in Foot and Ankle Surgery: A Review

“…Studies have demonstrated that the percutaneous triple Hoke hemi-section when compared with traditional open Z lengthening approach has approximately onethird of intraoperative time, fewer complications, and no statistically significant differences in therapeutic effect versus open techniques [28]. This method helps to maintain muscle strength and preserve function relative to traditional open Achilles' tendon lengthening procedures and minimizes risk of over lengthening.…”

Changes in the bony alignment of the foot after tendo-Achilles lengthening in patients with planovalgus deformity

“…Various operative methods such as arthroereisis, lateral column lengthening osteotomy, calcaneal medial displacement osteotomy, calcaneal-cuboid-cuneiform osteotomy, and arthrodesis can be considered to treat planovalgus foot deformity [ 3 – 5 , 8 , 10 – 14 ]. If ATC is present, tendo-Achilles lengthening (TAL) should be performed concomitantly with the planovalgus foot surgery [ 15 – 17 ].…”