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Comparison of Large-Gauge Needle, Corneal Knife, and No. 11 Blade for Percutaneous Achillotomy

An Experimental Study

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Background

In the Ponseti technique, the residual equinus deformity is corrected with percutaneous tenotomy. This experimental study aimed to compare the safety and effectiveness of a large-gauge needle, a corneal knife, and a No. 11 blade in percutaneous achillotomy performed in rats.

Methods

Ninety Achilles tendons of 45 Sprague-Dawley rats were analyzed, following division into three study groups. In the study, group I (needle), group II (corneal knife), and group III (No. 11 blade) were compared on the basis of bleeding, incision length, requirement for primary suture, range of motion, and resulting neurovascular injury at day 0. Moreover, the groups were compared in terms of range of motion, macroscopic and microscopic adhesions, and tenocyte morphology at days 21 and 42 postoperatively.

Results

On day 0, one suture was required in group III, whereas in groups I and II, no sutures were required. Postoperative bleeding was greater in group III and similar in groups I and II. Neurovascular injury was not observed in any of the groups. Three incomplete tenotomies were observed in group III and one incomplete tenotomy was observed in group II. Importantly, all tenotomies were complete in group I. In all groups, the range of motion was similar. The macroscopic adhesion score revealed high adhesion in group III (P = .009). According to Tang's criteria, microscopic adhesion was significantly higher on day 21 in group III compared with the other groups (P <0.001). No significant differences were observed in tenocyte morphology based on the Bonar criteria (P = .850).

Conclusions

In the results obtained from this animal study, we observed less bleeding, less adhesion, and less incomplete tenotomy in the large-gauge needle and corneal knife groups compared with the No. 11 blade group during the percutaneous Achilles tenotomy performed in rats.

Metin Sabancı Baltalimani Kemik Hastalıklari Eğitim ve Araştırma Hastanesi, Istanbul, Turkey. Dr. Alpay is now with Department of Orthopedics, Sultanbeyli State Hospital. Dr. Akbulut is now with Van Education and Research Hospital, VAN, Turkey. Dr. Cukurlu is now with Adıyaman Education and Research Hospital, Adıyaman, Turkey.

Universityof Health Sciences Turkey, Baltalimani Bone Diseases Training and Research Center.

Gazi University, Ankara, Turkey.

Corresponding author: Yakup Alpay, MD, Department of Orthopedics, Sultanbeyli State Hospital, Battalgazi Mahallesi, Paşaköy Cd. No:64, 34935 Sultanbeyli/Istanbul, Tukey. (E-mail: yakupalpayy@hotmail.com)