Percutaneous Achilles Tenotomy with a Large Gauge Needle in Ponseti Management of CTEV: A Modified Technique

Pandey, Ritesh Arvind; John, Bobby

doi:10.7860/jcdr/2017/30153.10806

Cited by 3 publications

(8 citation statements)

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“…The final 49 studies had a full-text review and only two were included in the final review. Six studies were identified through reference searches and included in the review, for a total of eight studies [12][13][14][15][16][17][18]21]. Seven studies were prospective cohort studies, and one study was an RCT.…”

Section: Systematic Review Findingsmentioning

confidence: 99%

“…The average follow-up was 5.4 months (SD 1.4 months) however only four of the included studies listed their length of follow-up. The needle sizes used for the tenotomy were usually 16 gauge; however, two studies used either 16- or 18-gauge needles depending on the patient's age [ 17 , 18 ] and Rahman et al used a 19-gauge needle [ 15 ]. All procedures were carried out in an outpatient setting.…”

Section: Reviewmentioning

confidence: 99%

“…Table 2 summarized the pre- and post-tenotomy scoring, recurrence rates and overall success of the procedure of the included studies. Four studies used the Pirani scoring system [ 22 ] to assess the severity of the clubfoot of patients pre- and post-tenotomy [ 12 , 13 , 15 , 17 ]. The mean pre-tenotomy Pirani score was 5.0 (SD 0.1) with the mean post-tenotomy score being 0.4 (SD 0.1).…”

Section: Reviewmentioning

confidence: 99%

“…To our knowledge, this is the first systematic review on the topic. Although Pandey et al [ 17 ] performed a literature search in their work, they did not present a systematic methodology.…”

Section: Reviewmentioning

confidence: 99%

“…Minokowitz et al were the first to describe Achilles tendon needle tenotomy in the literature with the use of a large bore needle as an alternative to a scalpel which is cost-effective, less disruptive for the family, and more comfortable for the child [11]. Although this technique has been reported in a number of literature, most of them have been conducted in Asian countries with no study or case series has been conducted in the United Kingdom [12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

A Systematic Review and Single Center Experience With Percutaneous Needle Tenotomy in Congenital Talipes Equinovarus (CTEV)

Dhingra¹,

Bak²,

Edokpayi³

et al. 2022

Cureus

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Percutaneous scalpel tenotomy is frequently performed as part of congenital talipes equinovarus (CTEV) to correct the equinus deformity. The use of a scalpel is associated with complications such as neurovascular bundle damage and pseudoaneurysms. In the literature, a percutaneous large-bore needle has been found to be a safer alternative to a scalpel for performing tenotomies. The goal of this study was to conduct a systematic review and report a single-center case series on the use of percutaneous needle tenotomy in the treatment of CTEV.A Preferred Reporting Items of Systematic Review and Meta-analysis (PRISMA)-compliant literature search was conducted to identify studies describing the use of a percutaneous needle tenotomy in the treatment of idiopathic CTEV. A retrospective case series of patients with idiopathic CTEV treated with percutaneous needle tenotomy over a seven-year period from a single center were also conducted. The patients' demographics, the location of the clubfoot, and the Pirani score were all recorded. An analysis of descriptive statistics was carried out. Continuous data were expressed as mean and SD, whereas categorical variables were expressed as absolute numbers and percentages (%).The systematic review included eight papers with a total of 1026 feet and a mean age of 10.4 weeks (SD 5.9). There were 47 (0.04%) complications across all studies, with a pooled success rate of 95%. Eleven patients (16 feet) were included in the single-center case study. The patients' initial Pirani score was 4.8 (SD 1.5), with a final score of 0. (SD 0). Four complications occurred in the patient's cohort -one minor bleeding and three recurrences as a result of poor compliance with the post-tenotomy foot abduction brace. In conclusion, the percutaneous Achilles tenotomy of a CTEV foot with a large bore needle is a safe and effective alternative.

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Section: Systematic Review Findingsmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Systematic Review and Single Center Experience With Percutaneous Needle Tenotomy in Congenital Talipes Equinovarus (CTEV)

Dhingra¹,

Bak²,

Edokpayi³

et al. 2022

Cureus

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Reliability of Percutaneous Achilles Tenotomy in the Treatment of Idiopathic Clubfoot

Kayondo,

El-Adwar,

Abdullah

et al. 2024

Journal of Pediatric Orthopaedics

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Background: Talipesequinovarus is a congenital ankle/foot malformation that commonly affects newborns. In its treatment using the Ponseti method, an Achilles tenotomy is frequently needed to correct residual equinus deformity. Percutaneous (PC) tenotomy is the most commonly used technique and needs to be thoroughly evaluated. The question we needed to answer was: "Does PC Achilles tenotomy result in complete tendon sectioning"?Methods: This clinical study included 56 idiopathic clubfeet in 36 patients who presented during the first 6 months of life and were treated with Ponseti manipulation and casting followed by PC Achilles tenotomy. PC tenotomy was done under general anesthesia, and Thompson's calf squeeze test was performed intraoperatively just after tenotomy. In case of a negative test (ie, ankle plantar flexion with calf squeeze), the percutaneous incision was extended to assess the cause of the negative test.Results: Forty-nine feet (87.5%) had a complete tenotomy, as evidenced by a positive Thompson's calf squeeze test. While 7 feet (12.5%) showed a negative test, and therefore the percutaneous incision was extended and all were found to have an incompletely divided Achilles tendon. The tendons were then completely divided, after which Thompson's test became positive in all. Conclusion:Percutaneous Achilles tenotomy is a reliable procedure, but was found to result in incomplete tendon sectioning in 12.5% of cases, affecting the range of ankle dorsiflexion. Thompson's squeeze test is reliable in picking up cases of incomplete tenotomy after the PC technique, and in these cases the incision should be extended for complete sectioning.

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Reproducibility of pop sensation, Thompson sign in achillotomy, and final Pirani score to predict clubfoot relapse: Achillotomy clinical signs and Pirani predictive ability

Charles-Lozoya,

Cobos-Aguilar,

Alvarado-Alanis

et al. 2024

Medicine

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Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore, surgeons’ reported feelings of tendon release (“click” or “pop”) and the Thompson sign could demonstrate that they are sensitive and reliable for confirming complete tendon release. The purpose of this study was to compare the reproducibility of clinical maneuvers that aim to detect the reported “click” or “pop” sensation by the surgeon and the Thompson sign after surgical release in percutaneous achilles tenotomy compare with US in patients with clubfoot. A cross-sectional reproducibility study of consecutive patients with idiopathic clubfoot was conducted. All the patients were scheduled to undergo tenotomy in the operating room using the standard percutaneous achilles tenotomy technique under sedation. The surgeon’s reported surgical sensation (“click” or “pop”) and Thompson signs were compared to the US assessment of the cut. The final Pirani score was used to predict recurrence risk and was correlated with the number of plaster casts and age. Forty-five feet were affected in 30 patients. Eighteen (60%) men. Age range: 1 to 60 months. The sensation of “click” or “pop” was recorded in 38 patients, and complete release was confirmed by US in 37 patients, for a sensitivity (Se) of 0.95 and specificity (Sp) of 0.63. Thompson signs were positive in 33 and 36 patients at 2 evaluations, with Se values of 0.87 and 0.92 and Sp values of 0.88 and 0.75, respectively. The Pirani final score, a predictor of recurrence risk, had an area under the curve of 0.80 (95% CI = 0.63–0.97; P = .005), Se = 0.78, and Sp = 0.56, with a cutoff point of 2.75. The feeling of achilles tendon release and Thompson sign had high sensitivity, prevalence, accuracy, and posttest probability. The confirmation of tendon release based on clinical signs could prevent the use of US.

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Percutaneous Achilles Tenotomy with a Large Gauge Needle in Ponseti Management of CTEV: A Modified Technique

Cited by 3 publications

References 0 publications

A Systematic Review and Single Center Experience With Percutaneous Needle Tenotomy in Congenital Talipes Equinovarus (CTEV)

A Systematic Review and Single Center Experience With Percutaneous Needle Tenotomy in Congenital Talipes Equinovarus (CTEV)

Reliability of Percutaneous Achilles Tenotomy in the Treatment of Idiopathic Clubfoot

Reproducibility of pop sensation, Thompson sign in achillotomy, and final Pirani score to predict clubfoot relapse: Achillotomy clinical signs and Pirani predictive ability

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