Ilizarov technique used for post-traumatic Achilles tendon contracture

Abstract

Objective To report treatment of post-traumatic Achilles tendon contracture with Ilizarov technique and tendon lengthening. Methods From March 2011 to December 2014, 27 cases of post-traumatic Achilles tendon contracture were treated at our department. They were 16 males and 11 females, 13 to 52 years of age (average, 31.2 years). The left side was affected in 13 cases and the right side in 14. Eighteen cases had simple Achilles tendon contracture while the other 9 were complicated with other foot deformities. The causes were soft tissue injury and fracture at the leg in 19 cases, Volkmann's contracture in 5, and unknown in 3. Based on the X-ray tibio-sole angle of the affected foot, the treatment protocols included Ilizarov distraction, lengthening of the Achilles tendon, tibialis posterior, flexor hallucis longus and flexor digitorum longus, and partial fusion of the foot joint. The deformity correction with the Ilizarov device started from the postoperative 7 days with a rate of 1 mm/day and continued until the ankle reached a dorsal flexion of 80°. This period lasted from 15 to 32 days (average, 23 days). The fixation was maintained for 6 weeks after the fixation angle was stabilized. After the external fixators were removed, the ankle was fixated with plaster or splints for 3 months. Results The follow-ups ranged from 6 to 36 months (average, 20 months). At the last follow up, 25 cases (92.6%) achieved a tibio-sole angle of 90° and natural walking postures. Two patients (7.4%) who had the tibo-sole angle rebounded to 105o needed a pad at the posterior sole to recover natural walking. Nine patients had foot digital flexion deformities which were not treated further. Conclusion For post-traumatic Achilles tendon contracture, Ilizarov technique combined with tendon lengthening is fairly effective and safe, leading to a low rate of recurrence. Key words: Achilles tendon; Contracture; External fixators; Ilizarov technique