title: The quality of Achilles tendon repair five to eight years after percutaneous tenotomy in the treatment of clubfoot: clinical and ultrasonographic findings.
abstract: OBJECTIVE
  Our aim was to describe the mid-term appearances of the repair process of the Achilles tendon after tenotomy in children with a clubfoot treated using the Ponseti method.
  
  
  METHODS
  A total of 15 children (ten boys, five girls) with idiopathic clubfoot were evaluated at a mean of 6.8 years (5.4 to 8.1) after complete percutaneous division of the Achilles tendon. The contour and subjective thickness of the tendon were recorded, and superficial defects and its strength were assessed clinically. The echogenicity, texture, thickness, peritendinous irregularities and potential for deformation of the tendon were evaluated by ultrasonography.
  
  
  RESULTS
  The appearance of the Achilles tendon was slightly abnormal, with more thickening and less conspicuous contours than a normal tendon. Its strength was grossly normal, with no insufficiency of the triceps surae. Ultrasonographic findings revealed a mild fusiform thickening in 12 children (80%). The tissue at the site of the repair had a slightly hypoechoic, fibrillar quality with hyperechoic striation and the anterior contour was irregular and blurred. There was a focal narrowing within the healing tissue in two children.
  
  
  CONCLUSIONS
  This mid-term evaluation of the ability of the Achilles tendon to repair after division suggests a combination of intrinsic and extrinsic mechanisms. There were minor abnormalities which did not appear to affect function. Cite this article: Bone Joint J 2017;99-B:139-44.
authors.affiliation: University of São Paulo, Av. Caramuru, nº 2100, apto 1424, Alto da Boa Vista, 14025-710, Ribeirão Preto, State of São Paulo, Brazil.
authors.forename: D A
authors.initials: DA
authors.lastname: Maranho
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, nº 3900, Monte Alegre, City: Ribeirão Preto, State of São Paulo, Brazil.
authors.forename: F H L
authors.initials: FH
authors.lastname: Leonardo
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, nº 3900, Monte Alegre, City: Ribeirão Preto, State of São Paulo, Brazil.
authors.forename: C F
authors.initials: CF
authors.lastname: Herrero
authors.affiliation: University of São Paulo, Av. Bandeirantes, nº 3900, Sub-sector: Monte Alegre, City: Ribeirão Preto, State of São Paulo, Brazil.
authors.forename: E E
authors.initials: EE
authors.lastname: Engel
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, nº 3900, Monte Alegre, City: Ribeirão Preto, State of São Paulo, Brazil.
authors.forename: J B
authors.initials: JB
authors.lastname: Volpon
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, nº 3900, Monte Alegre, City: Ribeirão Preto, State of São Paulo, Brazil.
authors.forename: M H
authors.initials: MH
authors.lastname: Nogueira-Barbosa
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000601:surgery*; D002675:Child, Preschool; D003025:Clubfoot / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography; D014945:Wound Healing / Q000502:physiology
keywords: Achilles tendon; Clubfoot; Morphology; Ponseti method; Ultrasonography