Jeng Clifford L, Campbell John T, Maloney Patrick J, Schon Lew C, Cerrato Rebecca A
Institute for Foot and Ankle Reconstruction at Mercy, Baltimore, MD, USA.
Foot Ankle Int. 2021 Apr;42(4):476-481. doi: 10.1177/1071100720969618. Epub 2020 Nov 17.
Surgeons frequently add an Achilles tendon lengthening or gastrocnemius recession to increase dorsiflexion following total ankle replacement. Previous studies have looked at the effects of these procedures on total tibiopedal motion. However, tibiopedal motion includes motion of the midfoot and hindfoot as well as the ankle replacement. The current study examined the effects of Achilles tendon lengthening and gastrocnemius recession on radiographic tibiotalar motion at the level of the prosthesis only.
Fifty-four patients with an average of 25 months follow-up after total ankle replacement were divided into 3 groups: (1) patients who underwent Achilles tendon lengthening, (2) patients who had a gastrocnemius recession, (3) patients with no lengthening procedure. Tibiotalar range of motion was measured on lateral dorsiflexion-plantarflexion radiographs using reference lines on the surface of the implants.
Both Achilles tendon lengthening and gastrocnemius recession significantly increased tibiotalar dorsiflexion when compared to the group without lengthening. However, the total tibiotalar range of motion among the 3 groups was the same. Interestingly, the Achilles tendon lengthening group lost 11.7 degrees of plantarflexion compared to the group without lengthening, which was significant.
Both Achilles tendon lengthening and gastrocnemius recession increased radiographic tibiotalar dorsiflexion following arthroplasty. Achilles tendon lengthening had the unexpected effect of significantly decreasing plantarflexion. Gastrocnemius recession may be a better choice when faced with a tight ankle replacement because it increases dorsiflexion without a compensatory loss of plantarflexion.
Level III, retrospective comparative study.
在全踝关节置换术后，外科医生经常会增加跟腱延长术或腓肠肌松解术以增加背屈。既往研究关注了这些手术对胫距关节整体活动的影响。然而，胫距关节活动包括中足和后足的活动以及踝关节置换部分。本研究仅在假体层面研究跟腱延长术和腓肠肌松解术对影像学上胫距关节活动的影响。
54例全踝关节置换术后平均随访25个月的患者被分为3组：（1）接受跟腱延长术的患者；（2）接受腓肠肌松解术的患者；（3）未行延长手术的患者。使用植入物表面的参考线在侧位背屈-跖屈X线片上测量胫距关节活动范围。
与未行延长手术的组相比，跟腱延长术和腓肠肌松解术均显著增加了胫距关节背屈。然而，3组之间的胫距关节总活动范围相同。有趣的是，与未行延长手术的组相比，跟腱延长术组跖屈减少了11.7度，具有显著性差异。
跟腱延长术和腓肠肌松解术均增加了关节置换术后影像学上的胫距关节背屈。跟腱延长术产生了意外的效果，显著降低了跖屈。当面对踝关节置换过紧的情况时，腓肠肌松解术可能是更好的选择，因为它增加背屈的同时不会导致跖屈的代偿性丧失。
III级，回顾性比较研究。
