Surgery

Biography

Biography: Simone Battibugli

Abstract

Introduction: Anterior tibial tendon transfer is a common procedure used to treat a residual forefoot dynamic supination in children with idiopathic clubfoot. Several anterior tibial tendon transfer techniques have been described however; currently there is no general agreement as to the best method of transferred tendon fixation. Th is prospective study of consecutive cases was proposed to assess and compare the results of two techniques pullout or anchor suture fi xation. Methods: Between 2001 and 2009, 78 relapsed clubfoot deformities were initially treated by one of the authors (AFL) with repeating serial casting (Ponseti's method). From those, 25 patients (34 feet) with exclusive residual dynamic forefoot supination were selected and underwent to anterior tibial tendon transfer. Patients were allocated consecutively in two groups discriminating the method of transferred tendon fi xation, as follows: Group I (anchor) which enrolled 13 patients (18 feet) average age 5.1 years (4.2–5.6 years) and Group II (pull-out) which enrolled 12 patients (16 feet) average age 5.54 years (4.3–7.2 years). Surgical procedure was performed similarly to all patients (n=25) by the same author (ALF) using the modifi ed Ponseti and Smoley technique with two dorsal foot incisions; over the anterior tibialis tendon and the other over the third cuneiform. Th e tendon was passed subcutaneously and secured in the third cuneiform. Th e pull-out fi xation involved passing the tendon through a drill hole to the bone with attachment of the tendon fi xation suture on the plantar aspect of the foot which was tensioned while the foot was dorsi-fl exed. Th e anchor fixation technique utilized a metallic suture anchor that was fi xed to the dorsal aspect of third cuneiform in the usual described fashion. Average follow-up Group I was 2.98 years (2–5.2). Group II was 2.37 years (1.2–4.2). Results: Average surgery duration was similar between the two groups; Group I average 32 minutes (24–42). Group II 28 minutes (23–37). Th e clinical results was based on the restoration of muscle balance and correction of dynamic forefoot supination as follows; Group I, there were 15 good (83.4%), 03 regular (16.6%) and no poor results. In group II, there were 14 good (87.5%), 02 regular (12.5%) and no poor results. Th e groups had statistically similar results (p=0.732). No patient in either group had subsequent relapse, failed fixation of the tendon transferred or required additional operative intervention associated with clubfoot deformity during the follow-up period. No major complications were found in both groups. Group I, one patient developed fi brous adhesion dorsal skin, which haven’t required any subsequent intervention. Group II, one patient developed a plantar pressure sore, which improved and healed aft er removing the plantar plastic button. Average procedure cost; anchor fixation U$ 1,400 and pull-out U$ 600. Conclusions: Our study results show that the amount of correction obtained and complications rate were similar between the two methods of fixation (anterior tibial tendon transfer) being the pool-out technique less expensive compared with anchor fixation.