Achilles tendon lengthening by triple hemisection in adult

BACKGROUND: The purpose of this study was to investigate the adequate distance between hemisections to prevent complete rupture in a triple hemisection Achilles tendon lengthening. METHODS: Achilles tendon lengthenings by open triple hemisection were done in 18 patients (25 ankles) with spastic paralysis and were followed for more than 1 year. RESULTS: There was a significant correlation between the sum of the gaps (partial thickness defects) after sliding and the amount of corrected angles. When the distal gap was regarded as 1, the ratio of the distal gap to the middle gap to the proximal gap was 1:1.3 (range 0.8 to 3.3):1.6 (range 0.8 to 4.0), and the ratio of the distal connecting portion to the proximal portion was 2.1 (range 0.3 to 8.8):1.9 (range 0 to 8.3). There were marked differences of this ratio in individual cases. There were no complete ruptures. There were two recurrences at the last followup. CONCLUSION: When the angle of correction is more than 30 degrees, there is a risk of complete rupture even though the distance between the hemisections are more than 4 cm.