Study suggests pantarsal arthrodesis may lower revision risk in dogs: full analysis

A new retrospective cohort study in Veterinary Surgery suggests pantarsal arthrodesis may offer a more predictable surgical path for some dogs with common calcaneal tendon pathology. Reviewing 89 surgeries in 80 dogs treated at five referral centers, investigators reported that pantarsal arthrodesis had short-term outcomes comparable to tendon repair, but a significantly lower risk of catastrophic complications requiring revision surgery. (pubmed.ncbi.nlm.nih.gov)

The paper addresses a familiar challenge in small animal orthopedics. Common calcaneal tendon injuries are uncommon, but they can be difficult to manage because success depends not just on tendon repair technique, but also on postoperative protection, tissue quality, chronicity of injury, and pet parent compliance. Older literature has described these injuries as often traumatic or degenerative, and prior reports have documented meaningful complication rates after repair, especially when prolonged immobilization is required. (pmc.ncbi.nlm.nih.gov)

In the new study, dogs were treated between January 2011 and December 2021, and pet parents later completed Liverpool Osteoarthritis in Dogs, or LOAD, questionnaires to help assess long-term outcome. Tendon repair with tarsocrural immobilization accounted for 51.7% of limbs, pantarsal arthrodesis for 36%, and temporary tarsocrural immobilization without tendon repair for 12.3%. Median time to final referral-center follow-up was 10 weeks, with a range of 6 to 256 weeks. While overall complication rates were not statistically different between tendon repair and arthrodesis, catastrophic complications were significantly more common after tendon repair with immobilization than after pantarsal arthrodesis, 26.1% versus 0%. The authors also reported no difference in the proportion of mildly affected dogs among the three surgical groups based on returned LOAD questionnaires, although only 23 questionnaires were completed. (pubmed.ncbi.nlm.nih.gov)

That last point is important. The study supports arthrodesis as a viable primary strategy in some cases, but it also reflects the limitations of retrospective referral-center data. Case selection likely influenced results, long-term client-reported outcome data were sparse, and the paper does not settle which dogs are best served by tendon reconstruction versus fusion. Even so, the signal around revision risk is hard to ignore, especially for practices counseling pet parents on expected recovery burden and the possibility of additional surgery. (pubmed.ncbi.nlm.nih.gov)

The broader literature gives that conclusion some context. A recent case report in Veterinary and Comparative Orthopaedics and Traumatology Open noted that pantarsal arthrodesis may serve as both a salvage procedure after failed Achilles repair and a first-line treatment when the risk of repair failure is high. Earlier reviews and biomechanical work have likewise emphasized that distal fixation strength, chronic degeneration, and calcaneal insertion pathology can make durable tendon repair challenging in some dogs. (thieme-connect.com)

There is also a useful parallel in feline surgery. A multicenter retrospective study from 11 referral centers reviewed 39 cats undergoing common calcaneal tendon repair and compared postoperative tarsocrural immobilization methods. Temporary internal fixation methods, including calcaneotibial screws or plate-based constructs, were associated with a 13% complication rate, compared with 54.2% for external immobilization methods such as transarticular external skeletal fixation or external coaptation. Catastrophic complications, reported in 5.2% of cases overall, occurred only in the external immobilization group, and 82% of cats regained full or acceptable clinical function long term, with more unacceptable outcomes in externally immobilized cats. That is not directly transferable to dogs, but it reinforces a broader orthopedic theme: postoperative stabilization strategy may be as important as the repair itself. (pubmed.ncbi.nlm.nih.gov)

Additional feline arthrodesis data, while focused on a different tarsal problem, also support the general feasibility of fusion procedures in small patients. In a small retrospective series of five cats with traumatic tarsometatarsal injuries treated with partial tarsal arthrodesis and plate fixation, there were no intraoperative or major postoperative complications. Four of five cats had transient postoperative paw swelling, four of five were not lame at final recheck, and one had mild weight-bearing lameness; one cat also developed mild iatrogenic tarsal valgus linked to incorrect plate contouring. The series is not about Achilles injury, but it adds practical context that plate-based tarsal arthrodesis can produce good functional recovery, while also carrying recognizable technical and short-term postoperative considerations.

Why it matters: For veterinary professionals, this study sharpens the preoperative conversation. In dogs with chronic disease, poor tendon quality, avulsion-type injuries, or limited tolerance for prolonged external support, pantarsal arthrodesis may offer a more dependable route with less risk of catastrophic failure and revision. That does not make fusion the default choice, particularly in younger or more athletic dogs where preserving tendon function remains attractive, but it does strengthen the case for presenting arthrodesis earlier in the decision tree rather than reserving it only for salvage. The supporting feline literature adds a consistent message: when postoperative stabilization is more robust and complications are lower, long-term function can still be acceptable to good. This is an inference based on the study’s complication profile and supporting literature, rather than an explicit treatment guideline. (pubmed.ncbi.nlm.nih.gov)

What to watch: The next step is better prospective evidence, ideally with standardized injury classification, rehabilitation protocols, and longer-term functional follow-up, to clarify which patients benefit most from primary arthrodesis versus tendon repair and which immobilization methods best reduce revision risk. Comparative data on internal versus external postoperative support will be especially useful, given the signal seen in both dogs and cats. (pubmed.ncbi.nlm.nih.gov)