Coagulation Factor Consumption and Medium- to Long-Term Outcomes of Achilles Tendon Lengthening With and Without External Fixation in Haemophilia.

INTRODUCTION

Achilles tendon lengthening combined with external fixation (EF) has shown promising outcomes in managing haemophilia-related Achilles tendon contracture.

AIM: To compare coagulation factor consumption and medium- to long-term outcomes between Achilles tendon lengthening with and without EF.

METHODS

Clinical data between December 2012 and April 2023 were retrospectively analysed. Patients were divided into the traditional surgery (TS) group and the EF group based on the fixation method. Inter-group comparisons were performed (p < 0.05 considered significant).

RESULTS

A total of 10 patients completed follow-up. The mean age was 25.8 ± 14.1 years, and the median follow-up duration was 3.17 [1.78, 12.1] years. During hospitalization, mean coagulation factor consumption was lower in the EF group (19.7 ± 11.9 vs. 31.5 ± 9.31 IU/kg*day). One-month post-discharge, consumption was similar (25.2 ± 2.61 vs. 22.3 ± 1.06 IU/kg*day). By the second month, the EF group showed lower consumption (14.3 [13.9, 23.8] vs. 22.6 [20.8, 23.1] IU/kg*day). Additionally, mean intraoperative blood loss was lower in the EF group (104 ± 109 vs. 207 ± 101 mL). The EF group required longer mean fixation times (99 [72.0, 104] vs. 44 [42.0, 54.0] days) and showed a higher complication rate (80% vs. 40%), but all resolved or without impact on daily life. However, one case of contracture recurrence occurred in the TS group. Satisfaction and improvement rates were higher in the EF group (80% vs. 60%). Only the difference in mean fixation time reached statistical significance.

CONCLUSION

Achilles tendon lengthening with EF may be a safer and effective strategy for managing haemophilia-related Achilles tendon contracture compared to TS. However, further studies are required to confirm these findings.