title: A mini-open technique for Achilles tenotomy in infants with clubfoot.
abstract: OBJECTIVE
  A tendoachilles lengthening (TAL) is indicated in over 85 % of cases treated with the Ponseti technique. A percutaneous TAL is often performed in the clinic. Reported complications from a TAL performed in the clinic include: bleeding due to injury to the peroneal artery, posterior tibial artery, or lesser saphenous vein; injury to the tibial or sural nerves; and incomplete release. The purpose of the present study is to report the results and complications of a mini-open TAL performed in the operating room (OR).
  
  
  METHODS
  The current study is a retrospective review performed among infants with idiopathic clubfoot who underwent a mini-open TAL from 2008 to 2015.
  
  
  RESULTS
  Forty-one patients underwent 63 TALs via a mini-open technique in day surgery. The average Pirani score was 5.8 prior to casting. The average number of casts applied prior to surgery was 5.2. The average age at the time of the TAL was 12.5 weeks (range 5-48 weeks). The average weight at the time of surgery was 7.3 kg (range 3.6-13 kg). No child had a delay in discharge or stayed overnight in the hospital. No anesthesia-related complications or neurovascular injuries occurred. No child needed a repeat TAL due to an incomplete tenotomy.
  
  
  CONCLUSIONS
  In conclusion, mini-open TAL performed in the OR is safe and effective in infants with clubfeet. No complications occurred and all patients were discharged on the day of surgery. Direct visualization of the Achilles tendon via a mini-open technique minimizes the risk of neurovascular injury and incomplete tenotomy.
authors.affiliation: Department of Orthopaedics, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, Entrance B, Suite 2200, Hershey, PA, 17033, USA. rmacneille@hmc.psu.edu.
authors.forename: Rhett
authors.initials: R
authors.lastname: MacNeille
authors.affiliation: Department of Orthopaedics, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, Entrance B, Suite 2200, Hershey, PA, 17033, USA. whennrikus@hmc.psu.edu.
authors.forename: William
authors.initials: W
authors.lastname: Hennrikus
authors.affiliation: Department of Orthopaedics, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, Entrance B, Suite 2200, Hershey, PA, 17033, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Stapinski
authors.affiliation: Department of Orthopaedics, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, Entrance B, Suite 2200, Hershey, PA, 17033, USA.
authors.forename: Garrett
authors.initials: G
authors.lastname: Leonard
keywords: Achilles tenotomy; Clubfoot; Mini-open; Ponseti; TAL
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