Long-term effects of patellar tendon advancement on patella height and proximal tibial growth

Abstract

foot StudyGroup score, PODCI =Pediatric outcomesData Collection Instrument and FRS= Functional Rating Score). Moreover, instrumented 3D gait analysis using the Oxford Foot Model was performed. The results were compared statistically by a nonparametric Mann–Whitney U test. Results:Both groupswere comparable at the beginning of treatment with no significant difference in the Pirani score (p=0.623). After 9.8 years of follow-up the Ponseti group presented superior in morphology (p=0.024), functional (p=0.006) as well as radiologic (p=0.023) evaluation according to ICFSG. Also PODCI (p=0.016) and FRS (p=0.005) showed better functional status of children treatedwith the Ponsetimethod. Children treatedwith surgery had more troubles performing sports (p=0.003) and experiencedmore pain (p=0.006), which might also led to inferior results in happinessdomainof PODCI (p=0.03).Moreover, thegait analysis showed deficient hindfoot dorsiflexion (p=0.039) in the surgical group. The forefoot kinematics did not show any differences between groups. Discussion: The most important finding comparing the longterm outcomes of Ponseti and surgical treatment is the increased stiffness and decreased range ofmotion at the ankle joint. Themost probable reason for that is the scarring. Over time and with longer follow-up studies surgeons began to realize that scarring can lead to stiffness, residual and/or recurrent deformity and pain. This negatively influenced the activities of daily living and resulted in a significantly poorer outcome within the PODCI. The most important limitation of the study is a smaller number of included subjects and therefore limited power of the study. This long-term, prospective, randomized and controlled trial showed the Ponseti method to be superior to surgical treatment in idiopathic clubfeet. Thanks to better morphology, function, radiological outcomes as well as the patient’s overall health and a better ability to participate in activities of daily living seems Ponseti method be a low cost low-tec technique available for the widest spectrum of patients.