Duration of immobilization after percutaneous sliding heel-cord lengthening

Heel-cord lengthening is commonly performed for contractures in neuromuscular disease. Immobilization after this procedure has ranged from 3 to 8 weeks. A three-part study was performed to determine adequate length of immobilization. Sixteen rabbits had surgical transection of the right gastrocsoleus tendon in phase 1. Healing was allowed for 1, 3, 5, or 7 weeks. Tendons were then studied by magnetic resonance imaging (MRI), mechanical testing, or histologic section. A marker for healing was determined by MRI. Seven children underwent percutaneous sliding heel-cord lengthening (PSHCL) in phase 2. Healing was studied by MRI. Based on the marker from phase 1, adequate healing occurred at 3 weeks. Thirty-one children underwent PSHCL for neuromuscular contracture in phase 3. Cast immobilization was maintained for 3 weeks (group 1) and for >3 weeks (group 2). There was no evidence of rupture or progressive lengthening after cast removal in either group.