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. 2016 Feb;10(1):19-23.
doi: 10.1007/s11832-016-0710-3. Epub 2016 Jan 29.

A mini-open technique for Achilles tenotomy in infants with clubfoot

Rhett MacNeille  1 , William Hennrikus  2 , Brian Stapinski  3 , Garrett Leonard  3
Affiliations

A mini-open technique for Achilles tenotomy in infants with clubfoot

Rhett MacNeille et al. J Child Orthop. 2016 Feb.

Abstract

Purpose: A tendoachilles lengthening (TAL) is indicated in over 85 % of cases treated with the Ponseti technique. A percutaneous TAL is often performed in the clinic. Reported complications from a TAL performed in the clinic include: bleeding due to injury to the peroneal artery, posterior tibial artery, or lesser saphenous vein; injury to the tibial or sural nerves; and incomplete release. The purpose of the present study is to report the results and complications of a mini-open TAL performed in the operating room (OR).

Methods: The current study is a retrospective review performed among infants with idiopathic clubfoot who underwent a mini-open TAL from 2008 to 2015.

Results: Forty-one patients underwent 63 TALs via a mini-open technique in day surgery. The average Pirani score was 5.8 prior to casting. The average number of casts applied prior to surgery was 5.2. The average age at the time of the TAL was 12.5 weeks (range 5-48 weeks). The average weight at the time of surgery was 7.3 kg (range 3.6-13 kg). No child had a delay in discharge or stayed overnight in the hospital. No anesthesia-related complications or neurovascular injuries occurred. No child needed a repeat TAL due to an incomplete tenotomy.

Conclusions: In conclusion, mini-open TAL performed in the OR is safe and effective in infants with clubfeet. No complications occurred and all patients were discharged on the day of surgery. Direct visualization of the Achilles tendon via a mini-open technique minimizes the risk of neurovascular injury and incomplete tenotomy.

Keywords: Achilles tenotomy; Clubfoot; Mini-open; Ponseti; TAL.

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Figures

Fig. 1
Fig. 1
Bilateral clubfoot in a newborn child
Fig. 2
Fig. 2
Small incision of the mini-open Achilles tenotomy. Incision made over the medial edge of the Achilles tendon
Fig. 3
Fig. 3
A small hemostat used to deliver the tendon from the wound for direct visualization prior to tenotomy
Fig. 4
Fig. 4
Tenotomy then performed only after direct visualization obtained
Fig. 5
Fig. 5
A long leg cast is applied for 4 weeks
Fig. 6
Fig. 6
The anatomic structures at risk when performing a tendoachilles lengthening (TAL): peroneal and posterior tibial arteries; lesser saphenous vein; and tibial and sural nerves
See this image and copyright information in PMC

References

    1. Burghardt RD, Herzenberg JE, Ranade A. Pseudoaneurysm after Ponseti percutaneous Achilles tenotomy: a case report. J Pediatr Orthop. 2008;28:366–369. doi: 10.1097/BPO.0b013e3181653b6f. - DOI - PubMed
    1. Changulani M, Garg N, Bruce CE. Neurovascular complications following percutaneous tendoachillis tenotomy for congenital idiopathic clubfoot. Arch Orthop Trauma Surg. 2007;127:429–430. doi: 10.1007/s00402-006-0267-6. - DOI - PubMed
    1. Dobbs MB, Gordon JE, Walton T, Schoenecker PL. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity. J Pediatr Orthop. 2004;24:353–357. doi: 10.1097/01241398-200407000-00002. - DOI - PubMed
    1. Jowett CR, Morcuende JA, Ramachandran M. Management of congenital talipes equinovarus using the Ponseti method: a systematic review. J Bone Joint Surg Br. 2011;93(9):1160–1164. doi: 10.1302/0301-620X.93B9.26947. - DOI - PubMed
    1. Iravani M, Chalabi J, Kim R, Ebramzadeh E, Zionts LE. Propofol sedation for infants with idiopathic clubfoot undergoing percutaneous tendoachilles tenotomy. J Pediatr Orthop. 2013;33(1):59–62. doi: 10.1097/BPO.0b013e318267037a. - DOI - PubMed

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