Comparison of three different methods of anterior tibial tendon transfer for relapsed clubfoot: A pilot study

Abstract

Introduction:The commonly techniques for anterior tibial tendon transfer (ATTT) for clubfoot are split transfers (Hoffer), whole transfers to cuboid (Garceau) or 3rd cuneiform (Ponseti). We compared these surgical ATTT methods for relapsed clubfoot. Material and methods: Thirty relapsed clubfoot (46 feet) patients initially treated with Ponseti casting technique were prospectively randomized for ATTT techniques. The outcome was evaluated in terms of foot inversion, eversion and ankle dorsiflexion. Results: Average follow up was 5.49 months. Whole transfers had better absolute ankle dorsiflexion than split transfers. Foot inversion was comparable in Hoffer and Ponseti transfers but better with Garceau transfers. For eversion, best values occurred with Ponseti transfers. Absolute values of ankle dorsiflexion, foot inversion and eversion obtained with spilt transfers were less than those obtained with whole transfers (statistically insignificant). Conclusions: No significant differences for foot or ankle function could be detected in this study using the various surgical ATTT techniques in short term follow up.

Anterior Tibial Tendon Transfer for Treatment of Recurrent Congenital Clubfoot Initially Treated According to Ponseti Method. Update and Systematic Review Of Literature

“…In the third study of this second group (medium-term follow-up study), the authors reported a series of 39 recurrent clubfeet treated by TATT and evaluated through a pedobarographic analysis and concluded that TATT resulted in improvements of pedobarographic parameters and in a more balanced foot postoperatively. The remaining articles are short term follow-up studies (33,34,(38)(39)(40), that analyzed overall 115 patients (158 relapsed clubfeet) treated by TATT; contrary to previous studies, in these articles, the surgical techniques used were different (Ponseti and Smoley, Garceau and Hoffer) and some surgical technique variations have been proposed. Also these studies emphasized that TATT procedure is effective, restoring the balance eversion/inversion strength of the foot with an improvement of the distribution of the plantar pressure of the foot (34) and, at the gait analysis, a normalization of the main components of dynamic clubfoot recurrence was observed (39) nique, but modified the anchor of the transferred tibialis anterior tendon using a transfixing wire, while Mindler et al (39), performed a three incisions as in the Garceau technique, but they fixed the tendon using both a Bio-Tenodesis screw and a plantar button.…”

“…TATT for Treatment of Recurrent CCF database, 16 from Cochrane library and 1 from references). After detailed evaluation based on inclusion and exclusion criteria, articles were screened and only 11 studies fulfilled the eligibility criteria of our study (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). The other studies were excluded for the following reasons: 70 articles did not meet the study design because the topic was not pertinent or have insufficient data or the deformities were initially treated by surgical procedures while 6 articles were published in a different language than in English.…”

“…The other studies were excluded for the following reasons: 70 articles did not meet the study design because the topic was not pertinent or have insufficient data or the deformities were initially treated by surgical procedures while 6 articles were published in a different language than in English. In conclusion, a total of 11 articles were enrolled in the present review (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40).…”

“…. Among them, Argawal et al(40) conducted a prospective randomized study on three groups of patients with relapsed clubfoot (30 patients; 46 clubfeet), treated by TATT performed by Ponseti and Smoley technique in 17 feet, by Garceau technique in 12 feet and by Hoffer technique in another 17 feet. The average patient's age at surgery was 6.48 years and the average follow-up 5.49 months.…”

Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual Clubfoot

“…18,20,31 Although this is an effective procedure, the placement of the button on the sole increases the risk of a pressure sore (Figure 1). Agarwal and colleagues 2 found no complications/recurrences in a pilot study of 30 patients (46 feet) treated with 3 common techniques for anterior tibial tendon transfer, using the external button as an anchor. However, this was at short-term follow-up (average of 5.5 months).…”