Differences in Outcomes Between Tendon Transfer Treatments of Congenital Clubfoot in Cerebral Palsy

Abstract

Category: Ankle; Other Introduction/Purpose: Cerebral palsy (CP) provides challenges when treating congenital clubfoot (CF) due to the presence of aberrant muscle tone and motor dysfunction. Split anterior tendon transfer (SPATT) and split posterior tendon transfer (SPOTT) are two ubiquitous treatments in the surgical repair of CP CF. Kling et. al. developed a three-tier grading system for documenting SPOTT outcomes; assigning excellent, good, or poor based on postoperative ambulation and functional dorsiflexion, this system has also been applied to SPATT recovery. The purpose of this study is to elucidate any difference in the outcomes of CP CF patients who receive SPOTT vs SPATT treatment. Methods: Following PRISMA guidelines a comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science. Collected publications represent all available literature on clubfoot. Articles were then screened by two independent reviewers at the title, abstract, and full-text level; only articles that detailed tendon-transfer treatment of pediatric patients with CF, CP, and contained three or more human subjects were included. Publications were excluded from screening if found to be duplicate articles, historical reviews, professional opinions, case reports, or contained non-human subjects. Two independent reviewers verified that each article met predetermined inclusion criteria at each level of screening. SAS statistical software was used to determine the relationship between positive and negative interventions outcomes, as well as patent demographics. Results: An initial search yielded 6,469 articles; after review 17 articles remained which described surgical tendon transfer: 12 (70.59%) split posterior tendon transfer (SPOTT) articles (mean-age 9.30 +- 2.57 years, mean follow-up length 60.03 +- 37.64 months), 5 (29.41%) split anterior tendon transfer (SPATT) articles (mean-age 10.12 +- 3.40 years mean follow-up length 64.16 +- 34.35 months). SPOTT papers included a total of 391 patients and 446 feet with a post-operative excellent & good rate of 90.48% and failure rate of 8.70%. SPATT papers included a total of 136 patients and 151 feet with a post-operative excellent & good rate of 71.22% and failure rate of 9.73%. Conclusion: These results show that the publication frequency of CP CF treatment by split posterior tendon transfer is higher than that of split anterior tendon transfer. Additionally, results of this systematic review indicate that there is a greater predicted positive outcome in SPOTT vs SPATT while there is no significant difference in predicted negative outcomes between procedures.