Two-Incision, Wire-Assisted Achilles Tendon Z-Lengthening: Surgical Technique and Case Report

Achilles tendon lengthening is an important surgical procedure to manage gastrocnemius-soleus complex contracture. Because the Achilles tendon fibers twist like Manila rope and torsion varies widely, it is very difficult for any current lengthening procedure to be performed that accurately follows the rotation of the fibers; thus, irregular sliding or repeated cutting of the fibers may result. We present a patient with Achilles tendon contracture in whom the tendon was divided coronally along the twisted fibers using a stainless-steel wire before hemisection for Z-lengthening; thus, hemisection could be performed not only with minimal invasion but also accurately. After tendon lengthening, ankle function was restored to near normal. After a 15-month follow-up time, improvement of ankle function was well maintained, and no complication, such as crouch gait, was observed. We believe this was owed to accurate division of the tendon fibers before lengthening, preservation of the paratenon and deep fascial tube, and the use of Z-lengthening.