Percutaneous achillotomy in the treatment of congenital clubfoot: should it be performed in the operating theater or the polyclinic?

Abstract

BackgroundThe aim of this study was to compare the efficacy, advantages, and complications of percutaneous achillotomy in the treatment of clubfoot with the Ponseti method when performed to two different groups under general anesthesia or polyclinic conditions with local anesthesia.MethodsA retrospective evaluation was made of 96 patients treated for clubfoot in our clinic between January 2013 and June 2016. Fifty-seven patients were separated into two groups according to whether the achillotomy was performed in polyclinic conditions with local anesthesia or under general anesthesia following serial plaster casting with the Ponseti method.ResultsThe characteristics of age distribution, mean week of tenotomy, side, and sex were similar in both groups. No statistically significant difference was determined between the two groups in respect to complication and recurrence. The durations of hospitalization-observation, separation from the mother, and fasting were found to be statistically significantly shorter in local anesthesia group.ConclusionAlthough the performance of percutaneous achillotomy with local or general anesthesia has different advantages, it can be considered that especially in centers with high patient circulation, achillotomy with local anesthesia can be more preferable to general anesthesia because it is practical and quick, does not require a long period of fasting or hospitalization, and has a similar complication rate to general anesthesia procedures.

Percutaneous Achilles tenotomy under local anaesthetic in the clubfoot clinic was safe during the COVID-19 pandemic, for both children and parents

“…The safety of Achilles tenotomies done under LA has been previously reported [ 8 , 9 ]. However, there is a paucity of literature investigating parental treatment acceptability and overall experience of Achilles tenotomies done under LA in a clinic setting.…”

“…This paper supported the use of LA approach due to reduction in separation time of carers and child, no starvation period and less burden on resources in high turnover centres. Overall, the available literature supports the protocol of performing the Achilles tenotomy under LA in the clinic [ 8 , 9 ].…”

“…Practice differs between centres as to the location and anaesthetic protocol for the tenotomy [ 3 , 8 – 10 ]. There is evidence to support both local anaesthesia (LA) and general anaesthetic (GA) for the procedure.…”

“…In 2012, Lebel et al demonstrated low readmission rates after tenotomy under LA [ 9 ]. A retrospective analysis comparing Achilles tenotomies under a GA to LA showed there was no statistical difference in terms of recurrence or complications between the two groups [ 8 ]. This paper supported the use of LA approach due to reduction in separation time of carers and child, no starvation period and less burden on resources in high turnover centres.…”

Clubfoot management in the Middle East: a survey-based review

“…Despite the general agreement observed on the necessity of starting the treatment as soon as possible, together with the necessity of performing the Achilles tenotomy in the majority of cases, mainly 1 to 2 casts before the end of the treatment, divergence was observed regarding the upper age limit for manipulation and casting and the suitable setting for the Achilles tenotomy, whether it is in the outpatient clinic or in the operating room. Both these subjects are still controversial in the literature as the upper limit of age for proposing a primary Ponseti treatment remains a moving target, and many papers in the literature fail to show superiority of a technique over the other (clinics vs. operating room for tenotomy) (5,50,51).…”