Effectiveness and Complications of Percutaneous Needle Tenotomy with a Large
Needle for Muscle Contractures: A Cadaver Study
#MMPMID26624990
Chesnel C
; Genêt F
; Almangour W
; Denormandie P
; Parratte B
; Schnitzler A
PLoS One
2015[]; 10
(12
): e0143495
PMID26624990
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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. METHOD: 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.
CONCLUSION: 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.
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