title: Effectiveness and Complications of Percutaneous Needle Tenotomy with a Large Needle for Muscle Contractures: A Cadaver Study.
abstract: BACKGROUND
  Twenty-two percent of institutionalised elderly persons have muscle contractures. Contractures have important functional consequences, rendering hygiene and positioning in bed or in a chair difficult. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not very effective and surgery may be required. Surgery is carried out in the operating theatre, under local or general anaesthesia but is often not possible in fragile patients. Mini-invasive tenotomy could be a useful alternative as it can be carried out in ambulatory care, under local anaesthesia.
  
  
  OBJECTIVE
  To evaluate the effectiveness of percutaneous needle tenotomy and the risks of damage to adjacent structures in cadavers.
  
  
  METHODS
  Thirty two doctors who had never practiced the technique (physical medicine and rehabilitation specialists, geriatricians and orthopaedic surgeons) carried out 401 tenotomies on the upper and lower limbs of 8 fresh cadavers. A 16G needle was used percutaneous following location of the tendons. After each tenotomy, a neuro-orthopaedic surgeon and an anatomist dissected the area in order to evaluate the success of the tenotomy and any adjacent lesions which had occurred.
  
  
  RESULTS
  Of the 401 tenotomies, 72% were complete, 24.9% partial and 2.7% failed. Eight adjacent lesions occurred (2%): 4 (1%) in tendons or muscles, 3 (0.7%) in nerves and 1 (0.2%) in a vessel.
  
  
  CONCLUSIONS
  This percutaneous needle technique effectively ruptured the desired tendons, with few injuries to adjacent structures. Although this study was carried out on cadavers, the results suggest it is safe to carry out on patients.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Hôpital Raymond Poincaré, AP-HP, CIC-IT 1429, 104 Boulevard Raymond Poincaré, Garches, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Chesnel
authors.affiliation: Department of Physical Medicine and Rehabilitation, Hôpital Raymond Poincaré, AP-HP, CIC-IT 1429, 104 Boulevard Raymond Poincaré, Garches, France.|Université Versailles Saint Quentin en Yvelines, « End:icap » U1179 INSERM, UFR des Sciences de la Santé-Simone Veil, Montigny-le-Bretonneux, France.|Trainer for the European School of Surgery, 45 Rue des Saints-Pères, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Genêt
authors.affiliation: Department of Physical Medicine and Rehabilitation, Hôpital Raymond Poincaré, AP-HP, CIC-IT 1429, 104 Boulevard Raymond Poincaré, Garches, France.
authors.forename: Waleed
authors.initials: W
authors.lastname: Almangour
authors.affiliation: Department of Physical Medicine and Rehabilitation, Hôpital Raymond Poincaré, AP-HP, CIC-IT 1429, 104 Boulevard Raymond Poincaré, Garches, France.|Université Versailles Saint Quentin en Yvelines, « End:icap » U1179 INSERM, UFR des Sciences de la Santé-Simone Veil, Montigny-le-Bretonneux, France.|Trainer for the European School of Surgery, 45 Rue des Saints-Pères, Paris, France.|Université Versailles Saint Quentin en Yvelines, « Handi-Resp » EA4047, UFR des Sciences de la Santé-Simone Veil, Montigny-le-Bretonneux, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Denormandie
authors.affiliation: Trainer for the European School of Surgery, 45 Rue des Saints-Pères, Paris, France.|Physical Medicine and Rehabilitation Department, Laboratoire d'anatomie, UE 3920, Jean Minjoz Hospital, University of Franche-Comté, 20 rue Ambroise Paré, Besançon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Parratte
authors.affiliation: Department of Physical Medicine and Rehabilitation, Hôpital Raymond Poincaré, AP-HP, CIC-IT 1429, 104 Boulevard Raymond Poincaré, Garches, France.|Trainer for the European School of Surgery, 45 Rue des Saints-Pères, Paris, France.|Université Versailles Saint Quentin en Yvelines, « Handi-Resp » EA4047, UFR des Sciences de la Santé-Simone Veil, Montigny-le-Bretonneux, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Schnitzler
mesh_terms: D002102:Cadaver; D003286:Contracture / Q000601:surgery*; D006801:Humans; D009339:Needles; D011183:Postoperative Complications / Q000209:etiology*; D012449:Safety; D058971:Tenotomy / Q000009:adverse effects* / Q000295:instrumentation*