Percutaneous Tendon Achilles Lengthening: What Are We Really Doing?. Issue 3 (14th September 2018) - de Cesar Netto, Cesar
Category: Hindfoot Introduction/Purpose: Percutaneous Achilles tendon lengthening (TAL) is a common procedure used to address equinus contracture of the foot. A triple hemisection technique has become popular due to its ease and efficiency. Several studies evaluate the surgical outcomes of this procedure, but currently, descriptive anatomical studies are lacking. The objective of the study was to evaluate the accuracy of performing Achilles tendon percutaneous hemisections, the amount of tendon excursion in the tensile gaps of the cuts after forced dorsiflexion and the improvement in the range of motion for dorsiflexion of the ankle joint. Methods: Ten fresh-frozen above-knee cadaveric specimens were used. A percutaneous triple hemisection of theAchilles tendon (proximal, intermediate, and distal) was performed. Maximum ankle dorsiflexion was evaluated pre- and postprocedure with a digital goniometer. After proper dissection, the relative width of the cuts was noted. Followingforced ankle dorsiflexion, displacement in the tensile gaps was measured in all 3 cuts with a precision digital caliper. Results: The overall relative width of the percutaneous cut was 51.3% ± 16.3% of the Achilles tendon diameter, 44.3%± 13.6% for the proximal cut, 50.3% ± 15.6% for the intermediate cut, and 59.3% ± 18.4% for the distal cut. Tendonexcursion averaged 13.0 ± 3.8 mm for the proximal cuts, 12.5 ± 4.7 mm for the intermediate cuts, and 8.2 ± 3.7 mm forthe distal cuts. One cadaver had a complete rupture of the Achilles tendon and was excluded from the excursion dataanalysis. The mean range of motion for ankle dorsiflexion was 8.1 ± 3.9 degrees preprocedure and 27.6 ± 5.3 degreespostprocedure. The dorsiflexion angle significantly increased (P < .0001) at an average of 19.5 ± 5.0 degrees following TAL. Conclusion: Our cadaveric study demonstrated that the percutaneous triple hemisection of the Achilles was an accuratetechnique that provided successful lengthening of the tendon and increased ankle dorsiflexion. Complete ruptures arepossible complications. Our cadaveric study showed that in a clinical situation, triple hemisections of the Achilles tendon can be performed reliably, with significant improvement of the ankle dorsiflexion, mainly through increased tendon excursion at the proximal and intermediate cuts, and with low risk of complete ruptures.