Percutaneous Achilles Tendon Lengthening

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Radiographic templating

2

Execute surgical workthrough

  • describes the steps of the procedure to the attending prior to the start of the case
  • describe potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • basic orthopedic set

2

Room setup and equipment

  • standard OR table
  • fluoroscopy

3

Patient positioning

  • place patient prone
  • place a thigh tourniquet
G

Draw Anatomic Landmarks and Tenotomy Site

1

Draw anatomic landmarks

  • draw medial and lateral border and insertion in calcaneus
H

Perform Tenotomies

1

Perform first tenotomy

  • make the first medial cut at the insertion of the tendon onto the calcaneus
  • this cut should be one half of the width of the Achilles tendon
  • if the heel is in varus , place the first and third cuts on the medial side
  • if the heel is in valgus place the first and third cuts on the lateral side

2

Perform second tenotomy

  • make the second tenotomy proximally and medially just below the musculotendinous junction

3

Perform third tenotomy

  • Makes cut midway between the 2 first cuts.
  • make the third cut laterally through half the width of the tendon midway between the two medial cuts
I

Perform Controlled Lengthening

1

Position the ankle

  • dorisflex the ankle to the desired angle
J

Wound Closure

1

Cover the incisions

  • these incisions do not require closure
  • place a sterile dressing on each incision

2

Place immobilization

  • place a long leg cast with the knee in full extension
  • weightbearing as tolerated on the leg
Postoperative Patient Care
 

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