Cadaveric Evaluation of Percutaneous Tendo-Achilles Lengthening: Comparing 3- and 5-cm Techniques

Percutaneous Achilles tendon lengthening (PATL) is a widely used procedure for addressing gastrocnemius and gastroc-soleus equinus contractures. This study evaluates the biomechanical and anatomical outcomes of PATL using different incision distances from the Achilles tendon insertion. Twenty matched-pair cadaveric specimens underwent PATL with incisions spaced either 3 or 5 cm apart. Key outcomes included ankle dorsiflexion improvement, tendon integrity, and sural nerve injury. The 3-cm incision group showed dorsiflexion improvements of 12.70° with a straight knee and 14.60° with a flexed knee, while the 5-cm incision group showed improvements of 10.50° and 12.40°, respectively. Both techniques effectively increased ankle range of motion, with 3-cm incisions yielding greater dorsiflexion gains and higher success rates for proximal hemisections. However, the 5-cm incision group demonstrated a higher incidence of incomplete proximal cuts and insufficient tendon sliding, leading to less effective lengthening. Sural nerve injuries were observed in 25% of specimens, and a 10% incidence of Achilles tendon rupture was recorded, particularly with 3-cm incisions. Anatomical variations in the gastrocnemius aponeurosis also influenced outcomes. These findings underscore the need for meticulous surgical planning and consideration of individual anatomical differences to optimize patient outcomes. Further clinical studies are recommended to confirm these results and guide future surgical practices.Level of Evidence:Level IV: Cadaveric Study.