Subcutaneous tenotomy of Achille's tendon in adults for ankle stiffness. Areview of 80 cases.

Purpose of the study Lengthening of Achille's tendon is part of surgical program for ankle stiff ness in equinus deformity. Usually this lengthening is done by opened surge ry with all the well-knowned advantages in term of adjustment. We used a pe rcutaneous method for Achille lengthening with a two stages tenotomy. The p urpose of this study is to evaluate advantages, inconvenients and efficienc y of the subcutaneous method versus the open method. Materials and Methods We present a retrospective study of a 80 percutaneous lengthening of Achill e's tendon in 78 patients done between August 85 and January 96. All patien ts who went to surgery during this period were reviewed. Mean age was 36 ye ars old and there was 39 left sides and 41 right sides. We separated the ex tra-articular stiffness (48 cases) and the intra-articular stiffness (32 ca ses) because rn extra-articular etiology the stiffness is a consequence of a primitive neuro-muscular disease as the ankle joint is healthy. 46 ankles had a past history of surgery. The kind of surgery was directely related t o the etiology of the equinus. Most of the time, Achille lengthening was th e last time of joint mobilisation. Only 15 times lengthening of the equinus tendon was done isolated. We looked at the early results for all patients and late results were only evaluated for the patients who had an isolated l engthening of the Achille tendon the for stastitical reasons. Results Median follow-up is two and an half years. There was preoperatively 59 ankl es equinus and correction was constantly obtained with surgery postoperativ e improvment was 12 degrees of dorsal ankle flexion. In sub population of i solated achillus lengthening mean gain is 17 degrees. Only one patient had a per-operative complication with an heel anesthesia. We had no late compli cation related to the method. Discussion Results of this reviewal confirms efficency of the percutaneous technique i n adult. Litterature is very poor concerning Achille's tendon lengthening i n adult surgery. It is a very widelly spread method in children. Only few a uthors have published about it in adults mainly about hemiplegic patients. Our method saves tourniquet time in heavy ankle surgery. There are no painf ul and sticky scar. Morbidity is very low because we only had one complicat ion related to the method. Healing up of tendon is very good, all patients being able to rase up on their toes. Conclusion A review of our cases showed us the real efficency of this technique. It's a very simple and quick method giving good results with low morbidity. For us there is no indication of open surgery for achille's tendon lengthening.