Evaluación ultrasonográfica del tendón de Aquiles en niños con pie equino varo aducto congénito posterior a tenotomía de Aquiles con el método de Ponseti. Seguimiento a 12 semanas / Sonographic evaluation of Achilles tendon healing in tenotomies for congenital clubfoot and Ponseti's treatment. A 12-week follow-up

Resumen: Objetivo: Determinar el tiempo de curación del tendón de Aquiles en pacientes pediátricos tratados mediante tenotomía de Aquiles con método Ponseti en el Hospital Shriners para Niños de México, AC. Material y métodos: Estudio experimental, analítico, prospectivo, longitudinal de pacientes con diagnóstico de pie equino varo aducto congénito idiopático en tratamiento con método Ponseti con evaluación estática y dinámica mediante ecógrafo en tiempo real Siemens Diagnostic Ultrasound System Sonoline 650 con transductor lineal de 10.5 mHz seriada del tendón de Aquiles previa a la tenotomía y a las tres, seis, nueve y 12 semanas tras el tratamiento quirúrgico. Resultados: Se obtuvo una muestra de 23 pacientes, 16 masculinos y siete femeninos, 16 con patología bilateral y siete unilateral, para un total de 39 pies, 18 derechos y 21 izquierdos, con una media de edad de 8.3 ± 2.3 meses. Previamente a la tenotomía, la anchura en corte longitudinal ultrasonográfico media fue de 2.7 ± 0.42 mm; en la semana tres, la media fue 3 ± 0.39 mm; a las seis semanas, 2.92 ± 0.36 mm; el ultrasonido de las nueve semanas reportó media de 2.84 ± 0.38 mm y a las 12 semanas, 2.82 ± 0.39 mm. Se compararon mediante t de Student el ancho prequirúrgico y a las 12 semanas, sin encontrarse diferencia p > 0.03. Conclusiones: La valoración ecográfica muestra integridad a las tres semanas posteriores a la tenotomía de Aquiles. Sin embargo, la reparación completa se logra a las 12 semanas.

Abstract: Objective: The aim of this study was to determine the healing time of Achilles tendon in pediatric patients treated with Achilles tenotomy with the Ponseti method in Shriners Children's Hospital of Mexico, AC. Material and methods: Experimental, analytical, prospective, longitudinal study of patients with a diagnosis of idiopathic congenital clubfoot treated with the Ponseti method with serial static and dynamic evaluation by ultrasound in real time with a Siemens Diagnostic Ultrasound System Sonoline 650, linear transducer 10.5 MHz of Achilles tendon before tenotomy and at three, six, nine and 12 weeks after the surgical treatment. Results: A sample of 23 patients, 16 male and seven female, 16 with unilateral and seven with bilateral pathology was obtained, for a total of 39 feet, 18 right and 21 left, with a mean age of 8.3 ± 2.3 months. Before tenotomy, the width was 2.7 ± 0.42 mm; in week three, the average was 3 ± 0.39 mm; at six weeks, 2.92 ± 0.36 mm; ultrasound at nine weeks reported an average of 0.38 ± 2.84 mm, and 2.82 ± 0.39 mm at twelve weeks. They were compared using Student's t presurgical width and at twelve weeks, without finding difference p > 0.03. Conclusions: Although there is integrity at three weeks after Achilles tenotomy, complete repair is achieved at 12 weeks.

Congenital talipes equinovarus

To determine the functional outcome of one stage posteromedial release in congenital clubfoot in terms of functional and radiological assessment. Forty five patients having clubfoot deformity were included in the study. Fifteen patients had bilateral deformities. The outcome was evaluated by functionally assessing the foot in the last review visit [at the end of 14th week of surgery] using the rating system of McKay, which has ten categories and has a maximum score of 180 points. It rates the outcomes as excellent good, fair, poor and failure [Fig -1]. Radiological assessment is made by measuring various angles on anteroposterior and lateral radiograph of the foot with gonometer at 3, 6, 10 and 14 weeks after release [Table -II]. The values of talocalcaneal angle [measured during every visit] on AP and lateral views will be summated to yield talocalcaneal index, and an index of >40 degree was taken as normal. Forty five patients included in the study with clubfoot deformity. Out of these patients, 33 [73.33%] were males and 12 [26.66%] were females [table -I]. They were graded according to the McKay rating system. In this short term follow up of one year, the following results were observed. Thirty-nine [65%] patients had excellent results, 11 [18.33%] patients had good results, 3 [5%] patients had fair results and 7 [11.66%] patients had poor results [Fig-1]. No case can be labeled as failure. Mild to moderated clubfoot deformities can be successfully treated in children up to five years of age by one stage postero-medial release

An incomplete form of lumbocostovertebral syndrome in association with atrial septal defect, arthrogryposis and clubfeet.

The present study describes a 9-month-old infant who presented with congenital lumbar hernia, kyphoscoliosis, atrial septal defect, congenital talipes equinovarus and arthrogryposis. To the best of our knowledge, this is the first case in English literature with this combination of defects. The case could be considered an incomplete form of the lumbocostovertebral syndrome. We also discuss the etiopathogenesis of these malformations.