Ultrasound-guided aponeurotomy and interphalangeal joint capsular release for treatment of Dupuytren’s disease

Villanueva, Manuel; Iborra, Álvaro; Fahandezh-Saddi, Homid; Sanz-Ruíz, Pablo; Noriega, Concepción

doi:10.1177/17531934221083815

Cited by 6 publications

(29 citation statements)

References 29 publications

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“…The Abbocath needle has been used in ultrasound-guided surgery for specific indications, such as Dupuytren’s disease, plantar fasciitis, and carpal tunnel syndrome [ 26 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Described the ultrasound-guided gastrocnemius recession technique using a needle in cadaver specimens. The same authors had previously described ultrasound-guided surgical techniques with a needle, namely, plantar fasciotomy and aponeurotomy for Dupuytren’s disease [ 26 , 27 ]. The use of an Abbocath needle for ultrasound-guided surgery has also been described for carpal tunnel syndrome [ 28 ] based on the same concept.…”

Section: Introductionmentioning

confidence: 99%

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Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II—clinical results

Iborra,

Villanueva,

Fahandezh-Saddi Díaz

2024

J Orthop Surg Res

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Background Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study is to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens. Methods and results We performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18–64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible flat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. We used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. We evaluated pre- and postoperative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle. Results Ankle dorsiflexion increased on average by 17.89°. The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months. The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months. Conclusion Ultrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist's office, with a very basic instrument set and local anesthesia, thus reducing expenses.

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“…The Abbocath needle has been used in ultrasound-guided surgery for specific indications, such as Dupuytren’s disease, plantar fasciitis, and carpal tunnel syndrome [ 26 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II—clinical results

Iborra,

Villanueva,

Fahandezh-Saddi Díaz

2024

J Orthop Surg Res

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“…To our knowledge, needle-based gastrocnemius lengthening has not been previously described. We believe that this viable and reproducible surgical procedure warrants further consideration [31][32][33].…”

Section: Introductionmentioning

confidence: 94%

Needle-based gastrocnemius lengthening: a novel ultrasound-guided noninvasive technique

Marcos¹,

Martínez²,

Díaz³

2022

J Orthop Surg Res

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Background Gastrocnemius tendon lengthening is performed to treat numerous conditions of the foot and ankle. Gastrocnemius shortening has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flat foot deformity, and metatarsalgia. Ultrasound-guided ultraminimally invasive lengthening of the gastrocnemius is a step forward in this type of surgery. It can be performed in both legs simultaneously without ischemia using only local anesthesia plus sedation and without the need for a cast or immobilization. The truly novel advantage of the procedure is that it can be performed in the office, without specific surgical instruments. The aim of our research was to prove the effectiveness and safety of a new closed needle-based ultrasound-guided surgical procedure for lengthening the gastrocnemius tendon. Methods and results We performed ultrasound-guided gastrocnemius tendon lengthening using a needle in eight fresh frozen specimens (3 left and 5 right). None of the specimens had been affected by disease or undergone previous surgery that could have affected the surgical technique. We used a linear transducer with an 8- to 17-MHz linear transducer and the beveled tip of an Abbocath as a surgical blade to perform the lengthening procedure. The gastrocnemius Achilles tendon recession was entirely transected in all eight specimens, with no damage to the sural nerve or vessels. The improvement in dorsal flexion was 15°. Conclusion Needle-based ultrasound-guided gastrocnemius tendon lengthening is safe, since the surgeon can see all structures clearly, thus minimizing the risk of damage. The absence of a wound obviates the need for stitches, and recovery seems to be faster. The procedure can be performed in a specialist's office, as no specific surgical instruments are required. This technique could be a valid option for gastrocnemius lengthening and may even be less traumatic than using a hook-knife, as in our previous description.

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“…La ecografía se puede utilizar para confirmar la fibromatosis palmar y para el tratamiento guiado por imágenes. [46][47][48] Aspecto ecográfico de la enfermedad de Dupuytren En la ecografía, las lesiones suelen localizarse directamente superficiales a los tendones flexores (93%), con su epicentro en la región del hueso metacarpiano distal (89%). Las lesiones de Dupuytren son característicamente hipoecogénicas (98%) y no comprimibles (95%).…”

Section: Enfermedad De Dupuytrenunclassified

“…La guía por ultrasonido se utiliza para la terapia de inyección de colagenasa o procedimientos quirúrgicos para evitar complicaciones de tendones y estructuras neurovasculares. 48 Durante los últimos diez años, las complicaciones y la recuperación posoperatoria a largo plazo asociadas con la fasciectomía limitada (FL) han llevado al uso de técnicas mínimamente invasivas, incluidas las inyecciones de colagenasa y la aponeurotomía percutánea con aguja (APA). [46][47][48][49][50][51][52][53] Una revisión sistemática de la literatura [49][50][51][52][53][54][55][56][57][58][59] demuestra una tasa general de complicaciones por debajo del 4 % con la APA.…”

Section: Enfermedad De Dupuytrenunclassified

Utilidad de la ecografía en la cirugía de la mano: Parte II

Díaz

Martínez

Fernández³

et al. 2022

Revista Iberoamericana de Cirugía de la Mano

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ResumenEn los últimos años, con los avances técnicos en la ecografía, aumentó la calidad de las imágenes, lo que ha permitido a los cirujanos mejorar su capacidad de evaluar la mano y la muñeca. Las infiltraciones ecoguiadas en cirugía de mano son más precisas y seguras en comparación con las infiltraciones sin el uso de ecografía. El desarrollo de la técnica de ecografía y de transductores de alta resolución nos ayuda a realizar procedimientos ecoguiados, como el tratamiento del dedo en gatillo, la liberación del síndrome del túnel carpiano, y la aponeurotomía en la enfermedad de Dupuytren. El objetivo de este trabajo es describir las técnicas ecográficas en el tratamiento de las patologías de la mano y el estado del arte de las cirugías ecoguiadas de la mano y sus resultados.

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Ultrasound-guided aponeurotomy and interphalangeal joint capsular release for treatment of Dupuytren’s disease

Cited by 6 publications

References 29 publications

Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II—clinical results

Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II—clinical results

Needle-based gastrocnemius lengthening: a novel ultrasound-guided noninvasive technique

Utilidad de la ecografía en la cirugía de la mano: Parte II

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