Tenoscopic Guided Resection of the Manica Flexoria Utilizing Radiofrequency Energy

Introduction: The manica flexoria (MF) is a tendinous collar of tissue within the digital flexor tendon sheath. Moderate to complete MF tears require resection, which typically is performed with sharp transection; however, this technique carries the risk of iatrogenic damage. The radiofrequency probe utilizes high-frequency electrical current to break down tissue, enabling the user control over the activation of cutting therefore minimizing accidental damage. The study objective was to evaluate the safety and efficacy of radiofrequency energy for MF resection.

Materials and Methods: The technique was evaluated on 18 cadaver limbs followed by two donated horses. The MF was resected utilizing the radiofrequency probe and the technique was evaluated. Limbs were dissected and scored on a 15-point scale where 15 was optimal. Evaluated areas included the completeness/smoothness of cut borders and iatrogenic damage. In the live horses, samples were obtained for histology and live/dead staining.

Results: In all horses complete transection of the MF was achieved with an average limb score of 14.54 ± 0.67. Ten mild iatrogenic lesions of <2 mm in size were identified, none of these were deemed to be clinically significant. The histological evaluation did not identify differences in cell architecture between samples exposed to RF energy and controls. The only samples with nonviable cells were the MF transacted borders with an average cell death depth of 175.9 ± 33.9 μm.

Discussion/Conclusion: The described technique utilizing radiofrequency energy represents a viable alternative to sharp transection for the tenoscopic guided resection of the MF. The procedure allowed for complete symmetric resection of the MF with minimal iatrogenic damage to surrounding tissues.

Acknowledgment

This project was funded by the ACVS surgeon in a training grant. The RF probes were kindly supplied by Arthrex for use in this project.

Publication History

Article published online:
15 July 2025