title: The influence of concomitant triceps surae lengthening at the time of total ankle arthroplasty on postoperative outcomes.
abstract: BACKGROUND
  Concomitant procedures are being performed with total ankle replacement (TAR) to improve alignment, function, and mobility. The purpose of this study was to examine the differences in outcomes between patients who had a concomitant triceps surae lengthening (gastrocnemius recession [GSR] or triple hemisection [TAL]) versus a group that underwent TAR alone preoperatively and 1 year after TAR.
  
  
  METHODS
  For this prospective, nonrandomized study, 229 patients (37 GSR, 22 TAL, and 170 TAR alone) were examined. Patient-reported outcomes, physical performance, and lower extremity gait mechanics were completed preoperatively and 1 year postoperatively. A series of repeated measures ANOVAs were used to determine significant differences (P < .05), and Tukey's post hoc testing was used to follow any significant ANOVA results.
  
  
  RESULTS
  No difference existed in BMI, age, gender, or dorsiflexion (DF) angle at heel strike between the triceps surae lengthening groups or between preoperative and 1 year following TAR. Walking speed, the physical performance measures, the AOFAS Hindfoot Score, SF-36, peak plantar flexion angle, and the peak plantar flexion moment were significantly improved (P < .001) postoperatively with no differences between the triceps surae lengthening groups. The peak DF angle (P = .006) and the ankle range of motion (P = .014) demonstrated a greater improvement from preoperative to 1 year postoperatively in the triceps surae lengthening groups in comparison to the TAR alone group.
  
  
  CONCLUSIONS
  Significant improvements existed between preoperative and 1 year postoperatively for most of the variables of interest independent of the triceps surae lengthening group. This study demonstrated that the use of a concomitant triceps surae lengthening procedure (GSR or TAL) resulted in equivalent outcomes when compared with a group undergoing TAR alone.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA Michael W. Krzyzewski Human Performance Laboratory, Duke University, Durham, NC, USA robin.queen@duke.edu.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Queen
authors.affiliation: Michael W. Krzyzewski Human Performance Laboratory, Duke University, Durham, NC, USA.
authors.forename: A Jordan
authors.initials: AJ
authors.lastname: Grier
authors.affiliation: Michael W. Krzyzewski Human Performance Laboratory, Duke University, Durham, NC, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Butler
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Nunley
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Easley
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Adams
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: DeOrio
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D058737:Arthroplasty, Replacement, Ankle; D003286:Contracture / Q000601:surgery; D005500:Follow-Up Studies; D005684:Gait; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D010003:Osteoarthritis / Q000601:surgery; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D016059:Range of Motion, Articular; D064232:Visual Analog Scale
keywords: ankle equinus; gastrocnemius recession; tendoachilles lengthening; total ankle replacement