Techniques, Anaesthesia preferences, and outcomes of Achilles tenotomy during Ponseti method
Abstract
A systematic review of 1,801 cases comparing outcomes of Achilles tenotomy performed in the Operating Room (OR) versus the Outpatient Department (OPD). Data confirms that OPD procedures under local anesthesia are safe, cost-effective, and clinically equivalent to those performed under general anesthesia.
Decentralizing the Tenotomy Standard
Key Finding
"Performing tenotomy in the OPD under local anesthesia showed no statistically significant difference in complication rates (p = 0.807) or repeat tenotomy rates (p = 0.875) compared to the OR."
Background: Achilles tenotomy is required in 80-90% of idiopathic clubfoot cases. Traditionally, many surgeons utilize the Operating Room under general anesthesia due to safety concerns. This review sought to dismantle the dogma that the OR is mandatory, evaluating whether the cost and resource-heavy OR setting offers any tangible clinical advantage over the clinic setting.
Methods: The authors conducted a systematic review of 19 studies encompassing 1,801 cases (2,674 clubfeet). Interventions were stratified by location (OR vs. OPD) and anesthesia type (General vs. Local). Primary endpoints were relapse/failure rates and complications (bleeding, neurovascular injury). Statistical analysis utilized a fixed-effects model for low heterogeneity and a random-effects model where I² is > 50%.
Results: The pooled failure rate for Achilles tenotomy was 4.2%. When comparing settings, OPD tenotomies had a repeat tenotomy rate of 2.5% versus 0.8% for OR tenotomies, a difference that was not statistically significant. Similarly, complication rates were statistically identical (1.6% in OPD vs. 0.5% in OR). Bleeding was the most common complication but was universally manageable with local pressure.
Conclusion: The Operating Room is an unnecessary expense for routine Achilles tenotomy. Moving this procedure to the Outpatient Department under local anesthesia maintains clinical safety standards while significantly reducing costs and avoiding the risks associated with infant general anesthesia.