TY - JOUR
T1 - Sonographically Guided Plantaris Tendon Release
T2 - A Cadaveric Validation Study
AU - Smith, Jay
AU - Alfredson, Håkan
AU - Masci, Lorenzo
AU - Sellon, Jacob L.
AU - Woods, Charonn D.
N1 - Publisher Copyright:
© 2018 American Academy of Physical Medicine and Rehabilitation
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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/m2 (mean 23.3 kg/m2). 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.
AB - 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/m2 (mean 23.3 kg/m2). 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.
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U2 - 10.1016/j.pmrj.2018.05.024
DO - 10.1016/j.pmrj.2018.05.024
M3 - Article
C2 - 29908296
AN - SCOPUS:85057478323
SN - 1934-1482
VL - 11
SP - 56
EP - 63
JO - PM and R
JF - PM and R
IS - 1
ER -