Abstract
To investigate the effect of Achilles tenotomy performed percutaneously and by mini-open methods on tendon healing and final strength. In two groups, each consisting of 14 rats, percutaneous and mini-open techniques in Achilles tenotomy were compared in terms of biomechanical, histological and gross properties. In the gross evaluation, it was observed that an obvious thickening and adhesion to the subcutaneous tissue of the healing tendon were observed in nearly all rats in which the mini-open technique was performed. In the biomechanical analysis, there was no significant difference between percutaneous and mini-open groups and between operated and intact Achilles tendons in both groups, in terms of tendon strength (P>0.05). In the histological evaluation, irregularity in the parallel pattern of the collagen fibres, emergence of a non-specific collagenous tissue formation and infiltration of mild mononuclear inflammatory cells were reported. These changes were more marked in the rats in which the percutaneous technique was performed. Mini-open technique for Achilles tenotomy may be considered as an alternative method of treatment to apply the tenotomy technique in a secure way. There are two basic advantages of Achilles tenotomy performed by the mini-incision open technique: (1) a complete tenotomy is guaranteed, as it has to be in the original Ponseti technique, (2) iatrogenic neuro-vascular injury risk is nearly completely avoided due to the subparatenon exploration of the tendon and direct visual observation during the transection. The mini-open technique may only be used in cases in which a vascular compromise is clinically suspected or confirmed by Doppler ultrasonography and/or arteriography. On the other hand, the technique may be performed in all cases routinely by the choice of the surgeon.
Highlights
Today, there is nearly universal consensus that the initial treatment of idiopathic congenital clubfoot should be nonoperative and/or minimally invasive, regardless of the severity of the deformity
The vascular anomalies of the lower limbs in idiopathic clubfoot are well studied in the literature and approximately 90% of these cases had absent or hypoplastic tibialis anterior artery [5, 9–11]
The peroneal artery is the main blood supply of the foot in the cases without both tibialis anterior and posterior artery, and much attention should be paid in order to avoid any injury during the procedures targeting Achilles tendon, because any injury of this vital artery may cause catastrophic results, including amputation, in these cases
Summary
There is nearly universal consensus that the initial treatment of idiopathic congenital clubfoot should be nonoperative and/or minimally invasive, regardless of the severity of the deformity. Ponseti demonstrated correction of most clubfeet in infants using proper manipulative techniques followed by the application of well-moulded long-leg plaster casts and a percutaneous tendo-Achilles tenotomy to correct residual equinus contracture [1]. It is possible access a number of reports published in the literature about this old but recently popularised technique. It is obvious that the Achilles tenotomy procedure is a worldwide popular technique due to a consideration of the relatively high incidence of clubfoot deformity. Percutaneous Achilles tenotomy is a relatively simple technique with low complication rates, articles reporting complications increases as the technique becomes more popular [5, 6]. Different tenotomy techniques and new designs of surgical blade modifications have taken place in the literature, in order to perform the technique in a safer fashion [5, 7]
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