Tenoscopic-guided resection of the manica flexoria utilizing radiofrequency energy. A proof of concept study.

Abstract

OBJECTIVE: To develop and optimize a tenoscopic technique for resection of the manica flexoria utilizing a radiofrequency probe. STUDY DESIGN: Experimental study. ANIMALS: Eighteen cadaver limbs and two experimental horses. METHODS: Tenoscopic-guided resection of the manica flexoria using radiofrequency energy proceeded sequentially by transection of the medial, lateral and proximal borders. The technique was performed in ex vivo limbs and then in vivo to replicate clinical scenarios. Time to complete resection of the manica flexoria (mean ± SD) and complications was recorded. Limbs were dissected and scored for features of transection and collateral injury on a 15-point scale (15 was optimal). Tenocyte viability and histology were performed on tissues from the in vivo procedures. RESULTS: Transection of the manica flexoria was achieved in all limbs (18/18 ex vivo and 8/8 in vivo). Surgery time was 30.6 ± 12.7 minutes (ex vivo) and 26.1 ± 7.5 minutes (in vivo). Limb scores representing iatrogenic damage and resection borders revealed an average ex vivo score of 14.3 ± 0.67 and live horse score of 14.8 ± 0.43. Histology and live/dead staining did not identify changes in tissue architecture and revealed minimal cell death following radiofrequency exposure. CONCLUSION: The described technique, utilizing radiofrequency energy, is a successful approach for safe transection of the manica flexoria. The procedure allowed for complete symmetric resection of the manica flexoria with minimal iatrogenic damage to surrounding tissues. CLINICAL SIGNIFICANCE: Resection of a torn manica flexoria may be technically challenging and utilization of sharp instrumentation risks accidental iatrogenic damage. Resection using radiofrequency represents a feasible alternative technique.