Ultrasonographic Evaluation of Achilles Tendon Repair After Percutaneous Sectioning for the Correction of Congenital Clubfoot Residual Equinus

Abstract

There is a fast reparative process after Achilles tendon percutaneous section that reestablishes continuity between stumps. The reparative tissue evolved to tendon tissue with a normal ultrasonographic appearance except for mild thickening, suggesting a predominantly intrinsic repair mechanism.

Ultrasonographic evaluation of clubfoot and it's correction by Ponseti method: a review

“…Transducer is placed vertically on the back of foot in midline partly on heel and partly on leg (Figure 7), to assess Tibiocalcaneal relationship, posterior compartment soft tissue thickness and length of tendoachilles ( Figure 8). Posterior projection is also important for evaluation of Achilles tendon percutaneous sectioning 20 and its repair as shown in study by Maranho D et al 20 Apart from these above discussed above Desai et al 11 also measured, talo-cuneiform angle, i.e. angle between a line drawn along the medial border of the talar ossific nucleus and another line along the medial border of the cuneiform at the anterior end of the talar nucleus.…”

“…These feet which are initially rigid later on showed spurious correction in some cases in study by Desai et al 11 and El-Adwar KL et al 21 Dynamic sonography thus can also guide to the timely need of operative intervention in unresponsive cases. 20 showed that it is necessary to ensure complete sectioning of the tendon, sometimes clinically unapparent connection may remain between the stumps which can theoretically influence the equinus correction. Therefore these connections if visualized need to be sectioned under ultrasound guidance.…”

Pé torto congênito

“…At six months after sectioning, the repair tissue was similar to the normal tendon. 125,126 Several instruments were used for percutaneous sectioning of the calcaneal tendon. Ponseti initially advocated the use of the ophthalmic scalpel blade.…”

“…The 1.6mm caliber needle has been employed more recently. [125][126][127][128] The surgical technique of tenotomy is more important than the instrument used. The entry point should be on the level of the medial edge of the calcaneal tendon, about 1.0 cm above the insertion, in order to avoid the posterior tibial neurovascular bundle.…”

“…The section should be assessed by palpation, with the extremity of the instrument. Ultrasonography can be used for transoperative evaluation of the tenotomy 125,126,128 , in order to ensure that it is complete and that the equinus is corrected.…”