Midterm follow-up of Achilles tendon repairing process after percutaneous sectioning in congenital clubfoot treated with the Ponseti method

• Grant number: 13/24479-3
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: March 01, 2014
• End date: February 28, 2015
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Daniel Augusto Carvalho Maranho
• Grantee: Fábio Henrique Luiz Leonardo
• Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

The Ponseti method has become the standard treatment of congenital clubfoot, due to low recurrence, complication, and reoperation rates, with high levels of good results and resolution. One of the main aspects of the Ponseti method is the percutaneous sectioning of the Achilles tendon to correct the residual equinus deformity. Although there are long-term clinical evidences that suggest a complete tendon repair, some hesitation remains among surgeons regarding the quality of tendon healing.After a complete tendon sectioning with a gap formation, a hematoma is initially formed, which evolves into a scar tissue whose cellular composition depends on several factors, such as biological age, location, blood support, tendon type, etc. It is supposed that children with congenital clubfoot develop a repairing process that is able to restore the connection between the stumps, with a predominantly tendineous tissue.Ultrasound is an imaging method that is suitable for evaluation of the tissue and the repairing process. The technique of sonoelastography assesses the tissue resistance against deformation, and generates indirect information about the hardness and stiffness of the scar tissue.In 2009, we published data on a series of patients, with sonographic evidence of a complete section of the Achilles tendon. The evolutive outcomes up to one year posttenotomy suggested a predominantly intrinsic repairing process. The current aim is to reassess these same patients about five years after tenotomy, to study the repairing process within a medium-term period. The tendon will be evaluated regarding the diameter, echogenicity, focal thickening, peritendinous adhesions, and capacity of deformation according to the sonoelastography.

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

MARANHO, D. A.; LEONARDO, F. H. L.; HERRERO, C. F.; ENGEL, E. E.; VOLPON, J. B.; NOGUEIRA-BARBOSA, M. H.. The quality of Achilles tendon repair five to eight years after percutaneous tenotomy in the treatment of clubfoot CLINICAL AND ULTRASONOGRAPHIC FINDINGS. BONE & JOINT JOURNAL, v. 99B, n. 1, p. 139-144, JAN 2017. (13/24479-3)