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Outcomes of Tibiotalocalcaneal Arthrodesis Through a Posterior Achilles Tendon-Splitting Approach.
Foot Ankle Int. 2016 Mar; 37(3):312-9.FA

Abstract

BACKGROUND

A number of operative approaches have been described to perform a tibiotalocalcaneal (TTC) arthrodesis. Here we present the largest reported series of a posterior Achilles tendon-splitting approach for TTC fusion.

METHODS

With institutional review board approval, a retrospective review of the TTC fusions performed at a single academic institution was carried out. Orthopedic surgeons specializing in foot and ankle surgery performed all procedures. Eligible patients included all those who underwent a TTC fusion via a posterior approach and had at least a 2-year follow-up. Forty-one patients underwent TTC arthrodesis through a posterior Achilles tendon-splitting approach. Mean age at surgery was 56.9±15.0 years. There were 21 female and 20 male patients. Preoperative diagnoses included arthritis (n = 13 patients), failed total ankle arthroplasty (9), avascular necrosis of the talus (9), prior nonunion of the ankle and/or subtalar joint (6), Charcot neuro-arthropathy (2), and stage IV flatfoot deformity (2). In 37 patients (90.2%), a hindfoot intramedullary arthrodesis nail was used, with posterior plate or supplemental screw augmentation in 17 patients. Posterior plate stabilization alone was utilized in 4 cases (9.8%).

RESULTS

The fusion rate was 80.4%. Eight patients developed a nonunion of the subtalar, tibiotalar, or both joints. Complications were observed in 17 patients (41.4%). Of these, ankle nonunion (19.5%), tibial stress fracture (17%), postoperative cellulitis and superficial wound breakdown (9.7%), subtalar nonunion (4.8%), and TTC malunion (2.4%) were the most frequently identified. One patient eventually underwent amputation (2.4%).

CONCLUSION

We believe that posterior Achilles tendon-splitting approach for tibiotalocalcaneal arthrodesis was a safe and effective method, with similar union and complications rates to some previously described techniques. We believe the posterior approach is advantageous as it provides simultaneous access to both the ankle and subtalar joints and allows for dissection to occur between angiosomes, which may preserve blood supply to the skin.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Hospital Clinico Universidad de Chile, Santiago, Chile.Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA james.nunley@duke.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26578482

Citation

Pellegrini, Manuel J., et al. "Outcomes of Tibiotalocalcaneal Arthrodesis Through a Posterior Achilles Tendon-Splitting Approach." Foot & Ankle International, vol. 37, no. 3, 2016, pp. 312-9.
Pellegrini MJ, Schiff AP, Adams SB, et al. Outcomes of Tibiotalocalcaneal Arthrodesis Through a Posterior Achilles Tendon-Splitting Approach. Foot Ankle Int. 2016;37(3):312-9.
Pellegrini, M. J., Schiff, A. P., Adams, S. B., DeOrio, J. K., Easley, M. E., & Nunley, J. A. (2016). Outcomes of Tibiotalocalcaneal Arthrodesis Through a Posterior Achilles Tendon-Splitting Approach. Foot & Ankle International, 37(3), 312-9. https://doi.org/10.1177/1071100715615398
Pellegrini MJ, et al. Outcomes of Tibiotalocalcaneal Arthrodesis Through a Posterior Achilles Tendon-Splitting Approach. Foot Ankle Int. 2016;37(3):312-9. PubMed PMID: 26578482.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of Tibiotalocalcaneal Arthrodesis Through a Posterior Achilles Tendon-Splitting Approach. AU - Pellegrini,Manuel J, AU - Schiff,Adam P, AU - Adams,Samuel B,Jr AU - DeOrio,James K, AU - Easley,Mark E, AU - Nunley,James A,2nd Y1 - 2015/11/17/ PY - 2015/11/19/entrez PY - 2015/11/19/pubmed PY - 2016/12/21/medline KW - arthrodesis KW - posterior approach KW - tibiotalocalcaneal SP - 312 EP - 9 JF - Foot & ankle international JO - Foot Ankle Int VL - 37 IS - 3 N2 - BACKGROUND: A number of operative approaches have been described to perform a tibiotalocalcaneal (TTC) arthrodesis. Here we present the largest reported series of a posterior Achilles tendon-splitting approach for TTC fusion. METHODS: With institutional review board approval, a retrospective review of the TTC fusions performed at a single academic institution was carried out. Orthopedic surgeons specializing in foot and ankle surgery performed all procedures. Eligible patients included all those who underwent a TTC fusion via a posterior approach and had at least a 2-year follow-up. Forty-one patients underwent TTC arthrodesis through a posterior Achilles tendon-splitting approach. Mean age at surgery was 56.9±15.0 years. There were 21 female and 20 male patients. Preoperative diagnoses included arthritis (n = 13 patients), failed total ankle arthroplasty (9), avascular necrosis of the talus (9), prior nonunion of the ankle and/or subtalar joint (6), Charcot neuro-arthropathy (2), and stage IV flatfoot deformity (2). In 37 patients (90.2%), a hindfoot intramedullary arthrodesis nail was used, with posterior plate or supplemental screw augmentation in 17 patients. Posterior plate stabilization alone was utilized in 4 cases (9.8%). RESULTS: The fusion rate was 80.4%. Eight patients developed a nonunion of the subtalar, tibiotalar, or both joints. Complications were observed in 17 patients (41.4%). Of these, ankle nonunion (19.5%), tibial stress fracture (17%), postoperative cellulitis and superficial wound breakdown (9.7%), subtalar nonunion (4.8%), and TTC malunion (2.4%) were the most frequently identified. One patient eventually underwent amputation (2.4%). CONCLUSION: We believe that posterior Achilles tendon-splitting approach for tibiotalocalcaneal arthrodesis was a safe and effective method, with similar union and complications rates to some previously described techniques. We believe the posterior approach is advantageous as it provides simultaneous access to both the ankle and subtalar joints and allows for dissection to occur between angiosomes, which may preserve blood supply to the skin. LEVEL OF EVIDENCE: Level IV, retrospective case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/26578482/Outcomes_of_Tibiotalocalcaneal_Arthrodesis_Through_a_Posterior_Achilles_Tendon_Splitting_Approach_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100715615398?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -