Extensile posterior approach to the ankle with detachment of the achilles tendon for oncologic indications.
BACKGROUND
We describe an extensile posterior approach to the ankle with detachment of the Achilles tendon for resection of extensive tumors involving the posterior ankle. To the best of our knowledge, this approach and its results have not been reported for oncologic indications.


METHODS
The surgical technique involved detachment of the Achilles tendon, tumor resection and reconstruction of the Achilles tendon with anchor sutures, and was used in six patients. The diagnosis was pigmented villonodular synovitis (5) and chondroblastoma (1).


RESULTS
At a mean of 6 (range, 2 to 10) years followup, all patients were free from tumor. All patients could walk an unlimited amount without any support. There were no problems with Achilles incompetence. The mean Musculoskeletal Tumor Society score was 97 ± 4.2% (range, 90 to 100) and the mean Achilles Tendon Total Rupture Score was 95 ± 5.7 (range, 87 to 100). One patient with screwed suture anchors had backing out of two anchors along with deep infection, requiring surgical debridement and anchor removal. One other patient had a post-traumatic small wound dehiscence which responded to local wound care.


CONCLUSIONS
Excellent exposure, tumor control and patient function were achieved by this approach in a select group of patients. The surgical technique described in this report offers another alternative for an extensile posterior approach to the ankle and/or subtalar joints.
Dept. of Orthopaedics and Rehabilitation, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA. adityavikramm@gmail.com
Aditya V
AV
Maheshwari
Jason A
JA
Walters
Robert M
RM
Henshaw
D000125:Achilles Tendon / Q000601:surgery*; D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D002804:Chondroblastoma / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D053441:Suture Anchors; D013586:Synovitis, Pigmented Villonodular / Q000601:surgery*