Kinematic and kinetic evaluation of the ankle joint before and after Achilles-tendon lengthening in patients with spastic diplegia

Equinus deformity of the foot presents a great number of difficulties to ambulant patients with cerebral palsy. Non-operative treatment of the incorrectible - fixed equinus is not successful. Many procedures are applied to treat it operatively, so its not clear which procedure at what age is the most successful. The purpose of this manuscript is to clarify the issue. The results of four procedures are analyzed: aponeurectomy of m. gastrocnemius, Achilles tendon lengthening by z-plasty, a combination of these two procedures and sliding elongation of m. triceps surae. The analysis was based on 417 operations in 291 patients of the average age of 9 years (1-64). The average follow-up was 7 years. The assessment of the results was based on the visual evaluation of the gait, on pedoscope prints and on comparison of ankle movements before and after operation. The analysis shows that the best results were achieved by sliding elongation of m. triceps surae after the age of 7.

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Re: Kinematic and Kinetic Evaluation of the Ankle Joint Before and After Tendo Achilles Lengthening in Patients With Spastic Diplegia J Pediatr Orthop 2005;25:479-483

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0b013e31802b68ca ◽

2007 ◽

Vol 27 (1) ◽

pp. 104 ◽

Cited By ~ 3

Author(s):

H. Kerr Graham ◽

Gary R. Natrass ◽

Paulo R. Selber

Keyword(s):

Ankle Joint ◽

Spastic Diplegia ◽

Kinetic Evaluation ◽

Before And After

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Triple Hemisection Percutaneous Achilles Tendon Lengthening for Severe Ankle Joint Deformity

Orthopaedic Surgery ◽

10.1111/os.13096 ◽

2021 ◽

Author(s):

Chang‐gui Zhang ◽

Xing‐yu Zhao ◽

Jin Cao ◽

Yang‐jing Lin ◽

Liu Yang ◽

...

Keyword(s):

Achilles Tendon ◽

Ankle Joint ◽

Joint Deformity ◽

Tendon Lengthening ◽

Achilles Tendon Lengthening

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

BioMed Research International ◽

10.1155/2019/1491796 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Yangjing Lin ◽

Jin Cao ◽

Changgui Zhang ◽

Liu Yang ◽

Xiaojun Duan

Keyword(s):

Achilles Tendon ◽

Recurrence Rate ◽

Operative Time ◽

Achilles Tendon Rupture ◽

Tendon Lengthening ◽

Group A ◽

Achilles Tendon Lengthening ◽

The Mean ◽

Group B

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.

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