The “Cello Technique”: A New Technique for Ultrasound-Assisted Calcaneoplasty

Abstract

The "cello technique" is a new calcaneoplasty technique for the treatment of Haglund disease. It is an ultrasound-assisted technique for resection of the posterosuperior part of the calcaneus. It is possible to resect the posterosuperior part of the calcaneus under direct ultrasound control with the patient in the prone position, with a dorsally positioned ultrasound probe, in line with the Achilles tendon fibers (sagittal line), and with the abrader in the posteromedial working portal. We describe in detail the technique for this new procedure in foot and ankle surgery. This innovative technique offers the possibility of expanding the indications for ultrasound-guided surgery in other fields of orthopaedic surgery.

A Novel Approach to Haglund Deformity Resection Using a Percutaneous Ultrasound-Guided Osteotomy Device

“…New percutaneous techniques using ultrasound-assisted (15,16) or fluoroscopic-guided (13,14) calcaneoplasty and a single posteromedial portal have been described using a bone abrader (Smith & Nephew, Andover, MA) (15,16) or Shannon burr (Miltex Instrument, Rietheim-Weilheim, Germany) (13,14). Advantages of these newer percutaneous techniques include using a single posteromedial portal, that heoretically minimizes the risk of sural nerve injury (15,16). One limitation of the traditional endoscopic ultrasound-guided techniques and the new percutaneous techniques is that associated Achilles tendon pathology could not be addressed (15,16).…”

“…Advantages of these newer percutaneous techniques include using a single posteromedial portal, that heoretically minimizes the risk of sural nerve injury (15,16). One limitation of the traditional endoscopic ultrasound-guided techniques and the new percutaneous techniques is that associated Achilles tendon pathology could not be addressed (15,16). In comparison, the novel technique described in this case report allows for both calcaneoplasty and tendon debridement of an intratendinous calcification through a single portal.…”

“…Calcaneoplasty is a common procedure for Haglund syndrome after failed conservative management and traditional surgical options include open or endoscopic approaches (8)(9)(10)(11)(12). Percutaneous calcaneoplasty under fluoroscopic or ultrasonography-assisted percutaneous surgery using a bur or bone abrader have been reported, but the literature on percutaneous procedures for Haglund syndrome or insertional Achilles tendinopathy is limited (13)(14)(15)(16). Current percutaneous treatment options appear to be reliable and effective, but the published techniques are unable to address pain generators within the Achilles tendon.…”

Ultrasonography-Guided Muscle Hematoma Evacuation

“…Thus, we used a shaver instead to be able to adequately remove the hematoma. Similarly, a case report done by Rakovac et al 6 . used the cello technique on Haglund deformity of the calcaneus wherein ultrasound-guided resection of the deformity was done using an abrader for bony resection of the calcaneal deformity.…”

Percutaneous surgery in the treatment of Haglund syndrome

“…After the exclusion and inclusion process shown in figure 1, eight studies were excluded and a total of 37 articles were selected for the present review (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) . Table 1 presents an overview of the study design, objectives and clinical outcomes of the 37 selected articles, including the main characteristics and findings.…”