Achilles Lengthening and TAR

Motion improvement is one goal patients and surgeons can agree on with total ankle replacement. In search of dorsiflexion (DF) motion, equinus contracture is often addressed as an adjunct procedure. Let's put aside the debate of tendo-achilles lengthening (TAL) vs. gastrocnemius-soleus recession (GSR) for a moment and look at the literature on achilles lengthening and TAR.

Stealing from PF to achieve DF

Johnson et al. published a level 3 retrospective review of 110 patients who underwent TAR with TAL (n=26), GR (n=29), or no lengthening procedure (n=55) with a minimum of 1-year ROM radiographic follow-up. The authors concluded that both TAL and GR increased postoperative dorsiflexion; however, this was accompanied by a reciprocal loss in PF. Minimal differences were observed for total arc of motion.

Another one that says we lose PF when we lengthen to achieve DF

Jeng et al. published on 54 TAR patients, average of 25 months follow-up, who were divided into these three groups: ​

1. achilles tendon lengthening

2. gastrocnemius recession

3. no lengthening procedure

They concluded that both TAL and GR significantly increased dorsiflexion when compared to the group without lengthening. However, the total ankle range of motion among the three groups was the same and the TAL group lost 11.7 degrees of PF compared to the group without lengthening, which was significant.

Lesson learned

If you are lengthening achilles, there is a real risk of decreasing PF in your zeal for DF.