Achilles tendon lengthening for ankle equinus deformity in hemophiliacs: 23 patients followed for 1-24 years.
BACKGROUND
Bleeding in the calf or ankle joint may lead to ankle equinus deformity, particularly in childhood and during adolescence. We assessed the long-term functional and radiographic results after Achilles tendon lengthening for ankle equinus deformity in hemophiliacs.


METHODS
Between 1975 and 1986, 30 hemophilic patients with pes equinus were surgically managed by Achilles tendon lengthening. Of these, 23 were followed up prospectively twice a year for an average of 13 (1-24) years. The mean age at operation was 29 (12-46) years. The clinical results were documented according to the score of the Advisory Committee of the World Federation of Hemophilia (WFH), while radio-graphs were evaluated using the Pettersson score. On average, preoperative ankle equinus deformity was 21 (5-55) degrees. Mean range of motion was 21 (5-42) degrees prior to surgery.


RESULTS
At the first postoperative examination 1 year after surgery, 21/23 cases were improved, and 9/21 reached dorsiflexion to at least neutral position. At the last follow-up, ankle equinus deformity was 10 (4-20) degrees on average. 20/23 patients still showed significant improvement compared to their condition before surgery. 7 patients still had complete correction of the equinus deformity, while mean range of motion decreased constantly over the observation period. The clinical score was significantly improved 1 year after surgery and diminished only slightly afterwards. Radio-graphic outcome deteriorated, with scores rising from 4.3 (1-10) points preoperatively to 7.3 (3-12) points at last follow-up.


CONCLUSIONS
Most patients treated for hemophilic pes equinus by Achilles tendon lengthening experienced long-term benefit concerning the equinus deformity, but gradually lost overall movement of the ankle joint. Progression of the ankle arthropathy cannot be hindered.
Department of Orthopedic Surgery, University of Bonn, Germany. wallny@st-bernhard-hospital.de
Thomas
T
Wallny
Hans
H
Brackmann
Clayton
C
Kraft
Claudia
C
Nicolay
Peter
P
Pennekamp
D000125:Achilles Tendon / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000601:surgery; D002675:Child, Preschool; D004863:Equinus Deformity / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome