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Ultrasonographic phases in gap healing following Ponseti-type Achilles tenotomy
Karanjit Singh Mangat1, Raj Kanwar, Karl Johnson
1Department of Paediatric Orthopaedics, Birmingham Children's Hospital, Birmingham B4 6NH, UK. Karanjit_mangat@hotmail.com
Insights
Achilles tendon healing after tenotomy for clubfoot takes at least twelve weeks to complete, as shown by ultrasound. This tendon healing timeline is crucial for planning further interventions.
Area of Science:
- Orthopedics
- Regenerative Medicine
- Medical Imaging
Background:
- The Ponseti technique is standard for clubfoot management.
- Achilles tenotomy is often performed to improve foot dorsiflexion.
Purpose of the Study:
- To describe ultrasonographic healing phases of the Achilles tendon gap after tenotomy.
- To investigate how healing varies with patient age.
Main Methods:
- Prospective ultrasonographic study of 27 tendons in 20 patients with idiopathic congenital clubfoot.
- Serial ultrasound examinations at 3, 6, and 12 weeks post-tenotomy.
- Healing defined by tendon homogeneity and indistinct divided ends on ultrasound.
Main Results:
- Three distinct phases of Achilles tendon gap healing observed.
- Healing phases were similar to tendons without a gap.
- Complete tendon structure recovery was often seen only at 12 weeks (13/21 tendons).
Conclusions:
- Achilles tendon continuity is evident by 3 weeks post-tenotomy.
- Complete tendon healing requires a minimum of 12 weeks.
- Consider the full healing time before planning revision Achilles tenotomy.
Background:
The Ponseti technique is well established in the management of clubfoot deformity, and an Achilles tenotomy is frequently performed to facilitate dorsiflexion of the foot. This report describes the ultrasonographic phases of healing of the tendon gap created by the Achilles tenotomy and how the healing varies, if at all, with patient age.
Methods:
A prospective ultrasonographic study of gap healing following a Ponseti-type tenotomy in twenty-seven tendons in twenty patients with idiopathic congenital clubfoot was performed. Serial ultrasound examinations (both static and dynamic) were performed at three, six, and twelve weeks after the tenotomy. The casts were removed routinely three weeks after the tenotomy. The end point of healing was defined as the observation of tendon homogeneity across the gap zone on ultrasound, with the divided tendon ends being indistinct.
Results:
Three phases of healing were apparent on ultrasound assessment at three, six, and twelve weeks after the tenotomy. These sequential phases are similar to those previously described in the healing of tendons with no gap. The transition to normal structure was frequently demonstrated by ultrasonography only at twelve weeks (in thirteen of twenty-one tendons).
Conclusions:
Although there is evidence of continuity of the Achilles tendon by three weeks after tenotomy, healing is not complete until at least twelve weeks. The time needed for the tendon to completely heal should be taken into consideration before a revision Achilles tenotomy is planned.
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