scholarly journals Z Lengthening of Achilles Tendon through Three Longitudinal Mini Incisions

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Mohamed Mokhtar Abd-Ella
Keyword(s):  
Achilles Tendon ◽  
Mouth Opening ◽  
Deformity Correction ◽  
Distal Portion ◽  
Foot Deformities ◽  
Capsular Release ◽  
Tendon Lengthening ◽  
Risk Of Rupture ◽  
Equinus Deformity ◽  
A New Technique

Category: Ankle Introduction/Purpose: Achilles tendon lengthening is considered an integral step in management of major foot and ankle deformities. Many procedures were described. Selective gastrocnemius recession is sometimes useful but is insufficient in severe equinus deformities in which the Achilles tendon itself needs to be lengthened. Z lengthening is sufficient to correct severe equinus deformities but is associated with marked scarring and tension on the wound after correction of the deformity. Percutaneous triple hemisection is an alternative but has the disadvantages of uncontrolled lengthening and risk of rupture in correcting severe deformities. In this study, a new technique of Z lengthening through three small longitudinal incisions to avoid the disadvantages of open Z lengthening and percutaneous triple hemisection was evaluated. Methods: Three longitudinal incisions of 1 to 1.5 cm were done, one over the most distal portion of the Achilles tendon and the second and third incisions over the midportion and the upper end of the tendon. Through the distal incision, the distal part of the tendon was split into two equal halves and the medial half was detached from the calcaneus and sutured. The suture was then passed using an artery forceps to the middle and then the superior incision with gentle pulling to complete the splitting of the two halves. Then, the lateral half was detached from the tendon proximally. Then, the equinus was corrected and the two halves were sutured together through the middle incision with removal of excess tendon. Longitudinal incisions were preferred to avoid fish mouth opening with deformity correction and to leave a chance to convert to open lengthening should posterior capsular release found necessary. Results: Ten patients with severe fixed equinus deformity alone or as an element of more complex foot deformities with clinically and radiologically reasonable ankle joints that can be preserved were included in the study. Three patients had poliomyelitis, two had Charcot-Marie Tooth syndrome, two had cerebral palsy, two had idiopathic equinocavus deformity and one had posttraumatic deformity. The average age was 24 years (range: 14-36). The follow up was at least six months. Equinus deformity was successfully corrected in all patients and the Achilles lengthening procedure was successful in all cases without need to convert to the classic open technique. No wound healing problems were encountered and the extensive scarring associated with open Z lengthening of the Achilles tendon was not encountered. Conclusion: Z lengthening of the Achilles tendon using three mini incisions can be a good option to treat severe equinus deformities with avoiding the complications of open Z lengthening and the percutaneous triple hemisection. It has however a limitation when posterior ankle capsular release is needed, but in such cases, the incisions can be connected converting the procedure to an open Z lengthening. Further studies are needed with larger number of cases and with comparison to other methods of Achilles lengthening.

scholarly journals A Formula to Predict the Magnitude of Achilles Tendon Lengthening Required to Correct Equinus Deformity

2019 ◽  
Vol 29 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Osman Nuri Ozyalvac ◽  
Evren Akpinar ◽  
Volkan Gur ◽  
Kubilay Beng ◽  
Mehmet Firat Yagmurlu ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Deformity Correction ◽  
Double Blind ◽  
Tendon Lengthening ◽  
Achilles Tendon Lengthening ◽  
Equinus Deformity ◽  
The Law ◽  
Law Of Cosines ◽  
Paediatric Orthopaedic ◽  
Blind Manner

Objectives: Achilles tendon lengthening (ATL) is one of the most commonly performed procedures in paediatric orthopaedic surgery. An appropriate adjustment of the amount of ATL is crucial to avoid insufficient or excessive lengthening. However, there is currently no effective method to preoperatively calculate the tendon length needed for equinus deformity correction. Thus, in this study we evaluated the accuracy of a calculation using a mathematical model based on the law of cosines. Methods: A total of 16 feet of 14 patients who were scheduled for ATL surgery due to equinus deformity were included in the study. ATL surgery was performed using a standard Z-plasty technique. Calculation of the amount of ATL using the law of cosines, and assessments of intraoperative lengthening of the tendon, were performed in a double-blind manner. The extent of lengthening resulting from the two methods was then compared. Results: The mean ATL determined intraoperatively was 23.67 ± 8.7 mm, and that obtained using the cosine-based method was 22.49 ± 8.6 mm. Thus, the new method showed excellent statistical agreement with the actual lengthening performed during surgery. Conclusions: The required dimension of ATL can be calculated preoperatively using the mathematical formula presented here. The advantages of this approach are that it allows accurate tendon lengthening and reduces the size of the surgical incision.

scholarly journals Change in the severity of congenital clubfoot in the first week of life

2020 ◽  
Vol 7 (4) ◽  
pp. 49-56
Author(s):  
Igor Yu. Kruglov ◽  
Nicolai Yu. Rumyantsev ◽  
Gamzat G. Omarov ◽  
Natalia N. Rumiantceva
Keyword(s):  
Deformity Correction ◽  
Varus Deformity ◽  
Foot Deformities ◽  
Idiopathic Clubfoot ◽  
Study Group ◽  
Congenital Clubfoot ◽  
Initial Examination ◽  
Global Literature ◽  
Equinus Deformity ◽  
Receive Treatment

Backgrоund. Congenital clubfoot or congenital equino-cava-varus deformity of the feet is one of the most common pathologies of the musculoskeletal system in children. Numerous articles in global literature have been published about changes in clubfoot severity during treatment; however, there are very few reports on how the severity of foot deformities with congenital clubfoot changes during the first week of life in the absence of deformity correction. Aim. To analyze changes in the severity of congenital clubfoot in the first week of life without any treatment. Materials and methods. The study group included 28 newborns with idiopathic congenital clubfoot (a total of 40 feet). The severity of clubfoot was evaluated on days one and seven after birth using the Dimeglio and Pirani scores. Results. During the initial examination of the newborns on the first day of life, the clubfoot severity recorded on the Pirani score was between 2 to 3 points and between 9 to 15 points on the Dimeglio score. Thus, in the first seven days of life in all patients who did not receive treatment, there was a significant increase in the severity of the equino-cava-varus deformity of the feet (p 0.05). The results of this study confirm that the severity of congenital clubfoot increases in the first week of life. This necessitates the beginning of the correction of severe idiopathic clubfoot in the first days after birth. Conclusions. The severity of congenital clubfoot during the first week of life significantly increased in all feet studied (p 0.05: 2 higher than in the table). If left untreated in the first week after birth, the equinus deformity progresses followed by varus deformity, anterior forefoot reduction, and, to a lesser extent, rotation.

Neglected Stiff Equinocavus Foot Deformity Treated with Cole Osteotomy, Combined with External Ilizarov Hinged Frame Fixation, Soft-Tissue Release, and Achilles Tendon Lengthening: A Case Report

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Konstantinos Tilkeridis ◽  
Anthimos Keskinis ◽  
Konstantinos Paraskevopoulos ◽  
Georgios Papadopoulos ◽  
Christos Chatzipapas ◽  
...  
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Achilles Tendon ◽  
Soft Tissue Release ◽  
Foot Deformities ◽  
Foot Deformity ◽  
Surgical Morbidity ◽  
Tendon Lengthening ◽  
First Case ◽  
Achilles Tendon Lengthening

Stiff equinocavus foot deformities are challenging clinical entities that may be treated with osteotomies and extensive soft-tissue release. The most common causes of such lesions are neglected trauma and Charcot-Marie-Tooth disease; other causes include burns, neurologic diseases, and compartment leg syndrome. Conventional treatments, including extensive soft-tissue release, osteotomies, and arthrodesis combined with or without internal splinting, may result in severe complications such as neurovascular or soft-tissue damage and shortening of the foot. The Ilizarov technique may be superior to the traditional approach, because it allows surgeons to apply gradual and titrated correction of individual components of complex deformities and results in minimal surgical morbidity without shortening of the foot. This is the first case report in the literature describing the simultaneous use of Cole osteotomy, combined with external Ilizarov hinged frame fixation, soft-tissue release, and Achilles tendon lengthening for the treatment of an extreme neglected stiff equinocavus foot deformity.

scholarly journals Achilles tendon lengthening for ankle equinus deformity in hemophiliacs: 23 patients followed for 1–24 years

2006 ◽  
Vol 77 (1) ◽  
pp. 164-168 ◽  
Author(s):  
Thomas Wallny ◽  
Hans Brackmann ◽  
Clayton Kraft ◽  
Claudia Nicolay ◽  
Peter Pennekamp
Keyword(s):  
Achilles Tendon ◽  
Tendon Lengthening ◽  
Achilles Tendon Lengthening ◽  
Equinus Deformity

scholarly journals Choice of operative procedures to correct equinus deformity in patients with cerebral palsy

2006 ◽  
Vol 53 (4) ◽  
pp. 21-26 ◽  
Author(s):  
G. Cobeljic ◽  
Z. Vukasinovic ◽  
M. Apostolovic ◽  
Z. Bajin
Keyword(s):  
Cerebral Palsy ◽  
Achilles Tendon ◽  
Operative Treatment ◽  
Triceps Surae ◽  
Visual Evaluation ◽  
Tendon Lengthening ◽  
Before And After ◽  
Achilles Tendon Lengthening ◽  
Equinus Deformity

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.

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

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
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.

scholarly journals Knotless Reconstruction of Chronic Achilles Tendon Ruptures With <3-cm Defects: Technique Tip

2021 ◽  
Vol 6 (4) ◽  
pp. 247301142110505
Author(s):  
Justin C. Haghverdian ◽  
Christopher E. Gross ◽  
Andrew R. Hsu
Keyword(s):  
Achilles Tendon ◽  
Skin Incision ◽  
Surgical Reconstruction ◽  
Fixation Strength ◽  
Level Of Evidence ◽  
Functional Deficits ◽  
Tendon Lengthening ◽  
Soft Tissue Dissection ◽  
Tendon Ruptures ◽  
Gait Abnormalities

Chronic Achilles tendon ruptures can result in tendon lengthening and significant functional deficits including gait abnormalities and diminished push-off strength. Surgical intervention is typically required to restore Achilles tension and improve ankle plantarflexion strength. A variety of surgical reconstruction techniques exist depending on the size of the defect and amount of associated tendinosis. For smaller tendon defects 2 to 3 cm in size, primary end-to-end repair using an open incision and multiple locking sutures is an established technique. However, a longer skin incision and increased soft tissue dissection is required, and failure at the suture-tendon interface has been reported that can result in postoperative tendon elongation and persistent weakness. In this report, we describe a novel technique to reconstruct chronic midsubstance Achilles tendon ruptures using a small incision with knotless repair of the tendon secured directly to the calcaneus. This technique minimizes wound healing complications, increases construct fixation strength, and allows for early range of motion and rehabilitation. Level of Evidence: Level V, Expert Opinion.

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