Surgeon swaps TCC for tendon lengthening

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Biomechanics Magazine June 2006 http://biomech.com

Surgeon swaps TCC for tendon lengthening

By: Jordana Bieze

J. Monroe Laborde, MD, and colleagues at Orthopedic Associates of New

Orleans have achieved such low ulcer recurrence rates using tendon

lengthening that the surgeons have virtually abandoned total contact

casting.

" Once a patient gets an ulcer, the best treatment, I believe, is

tendon lengthening, " Laborde said in presenting his results at the

annual AAOS meeting in March. " You don't have to use total contact

casting any more to get an ulcer to heal. "

It's hard to argue with his results. In 19 ulcers treated with

gastrocsoleus resection (along with peroneus longus lengthening for

first metatarsal head ulcers and intramuscular lengthening of the

tibialis posterior for fifth metatarsal head ulcers), three ulcers

recurred during an average follow-up period of 40 months. Two of

those ulcers healed after repeat tendon lengthening. These results

compare favorably to the previously reported two-year recurrence rate

of 38% with Achilles tendon lengthening (see " Plantar ulcers respond

to Achilles lengthening, " May 2004, page 35). Two-year ulcer

recurrence with total contact casting has been reported to be as low

as 20% and as high as 81%.

The New Orleans practitioners also appear to be duplicating their

success in the toes, using a 15-minute toe flexor tenotomy procedure

to heal neuropathic toe ulcers. Of 24 such ulcers, they saw

recurrence in three of 13 first toe ulcers and none of 11 lesser toe

ulcers during an average follow-up period of 32 months. All

recurrences healed with repeat tenotomy.