Sonographically Guided Plantaris Tendon Release: A Cadaveric Validation Study.
Journal
PM & R : the journal of injury, function, and rehabilitation
ISSN: 1934-1563
Titre abrégé: PM R
Pays: United States
ID NLM: 101491319
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
23
09
2017
accepted:
28
05
2018
pubmed:
17
6
2018
medline:
10
3
2020
entrez:
17
6
2018
Statut:
ppublish
Résumé
The plantaris tendon (PT) has been implicated in the pathogenesis of symptoms in a subset of patients with Achilles region pain syndromes and traditionally has been managed via open surgical resection. Although the PT can be visualized on ultrasound, a minimally invasive technique for sonographically guided PT release has not been formally described. To validate a technique to perform sonographically guided PT release in an unembalmed cadaveric model. Prospective, cadaveric laboratory investigation. Procedural skills laboratory in a tertiary medical center. Twenty unembalmed cadaveric knee-ankle-foot specimens (10 right, 10 left) obtained from 16 donors (6 male, 10 female) ages 55-96 years (mean 82.6 years) with body mass indexes of 14.1-33.2 kg/m After simulated local anesthesia and sonographically guided hydrodissection of the plantaris tendon-Achilles tendon interval, a single experienced operator performed sonographically guided PT release on each specimen using an in-plane, lateral-to-medial approach, a commercially available, disposable 3.0-mm hook knife, and either a 17-5 MHz or 15-7 MHz linear array transducer. Each specimen was subsequently dissected to assess for PT release and iatrogenic injury. Status of the PT, Achilles tendon, and regional neurovascular structures as determined by dissection. All 20 PT releases were completed in a single attempt through a 3- to 5-mm incision. Dissection confirmed complete PT release in all specimens without damage to the adjacent Achilles tendon or regional neurovascular structures. Sonographically guided PT release is technically feasible and can be performed while avoiding injury to the Achilles tendon and regional neurovascular structures. Additional research is warranted to further define the role of sonographically guided PT release in patients with suspected PT-mediated Achilles region pain syndromes. IV.
Sections du résumé
BACKGROUND
The plantaris tendon (PT) has been implicated in the pathogenesis of symptoms in a subset of patients with Achilles region pain syndromes and traditionally has been managed via open surgical resection. Although the PT can be visualized on ultrasound, a minimally invasive technique for sonographically guided PT release has not been formally described.
OBJECTIVE
To validate a technique to perform sonographically guided PT release in an unembalmed cadaveric model.
DESIGN
Prospective, cadaveric laboratory investigation.
SETTING
Procedural skills laboratory in a tertiary medical center.
SUBJECTS
Twenty unembalmed cadaveric knee-ankle-foot specimens (10 right, 10 left) obtained from 16 donors (6 male, 10 female) ages 55-96 years (mean 82.6 years) with body mass indexes of 14.1-33.2 kg/m
METHODS
After simulated local anesthesia and sonographically guided hydrodissection of the plantaris tendon-Achilles tendon interval, a single experienced operator performed sonographically guided PT release on each specimen using an in-plane, lateral-to-medial approach, a commercially available, disposable 3.0-mm hook knife, and either a 17-5 MHz or 15-7 MHz linear array transducer. Each specimen was subsequently dissected to assess for PT release and iatrogenic injury.
MAIN OUTCOME
Status of the PT, Achilles tendon, and regional neurovascular structures as determined by dissection.
RESULTS
All 20 PT releases were completed in a single attempt through a 3- to 5-mm incision. Dissection confirmed complete PT release in all specimens without damage to the adjacent Achilles tendon or regional neurovascular structures.
CONCLUSION
Sonographically guided PT release is technically feasible and can be performed while avoiding injury to the Achilles tendon and regional neurovascular structures. Additional research is warranted to further define the role of sonographically guided PT release in patients with suspected PT-mediated Achilles region pain syndromes.
LEVEL OF EVIDENCE
IV.
Identifiants
pubmed: 29908296
pii: S1934-1482(18)30310-1
doi: 10.1016/j.pmrj.2018.05.024
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
56-63Informations de copyright
© 2018 American Academy of Physical Medicine and Rehabilitation.