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

Anterior tibial tendon transfer in idiopathic clubfoot: pull-out vs. other fixations - a systematic review

PURPOSE

Review the literature and describe the complications associated with each of the anterior tibial tendon transfer (ATTT) techniques described.

METHODS

A systematic review of the literature was performed with the keywords ''clubfoot'', ''Ponseti'' and ''anterior tibial''. Studies in patients with clubfoot recurrence, who underwent ATTT, whose method of tendon fixation was different from the classical method, were included.

RESULTS

Six studies were included in this systematic review, which described multiple techniques for tibialis anterior fixation: bone anchors, interference screws, endobotton, K-wires, transosseous suture, and suture to the plantar fascia. In the papers that described postoperative complications, no major complications were reported, however the samples are generally small.

CONCLUSION

Several options have now emerged for tendon fixation in tendon transfers around the foot and ankle, including ATTT for treatment of relapsed clubfoot. To our knowledge this is the first paper that questioned the potential complications associated with the use of these new techniques. Due to the scarcity of published works in favor of other fixation methods, we believe that the traditional method is the optimal one for the transfer of the tendon of the tibialis anterior muscle.

A Novel Orthoplastic Reconstruction of Relapsed Clubfoot With Total Ankle Arthroplasty

Congenital clubfoot is addressed in infancy and rarely persists into adulthood. Ankle arthroplasty is an increasingly popular surgical intervention for patients with ankle arthritis since it allows a natural ankle range of motion and completely replaces a degenerative hindfoot. Here, we describe the first successful total ankle arthroplasty (TAA) for a patient with previously treated congenital clubfoot that reverted later in life. To address the patient's poor soft-tissue integument and reduce the likelihood of post-surgical complications, a perioperative latissimus muscle-free flap was performed. This two-staged, novel orthoplastic intervention addressed our patient's ankle issues and appears to be a viable option for clubfoot patients.

Tibialis anterior tendon transfer using bone anchor for dynamic supination in congenital talipes equinovarus

Tibialis anterior tendon transfer (TATT) is a recognised procedure for the treatment of recurrent congenital talipes equinovarus. The most common technique in use requires three skin incisions and breaching of the plantar tissues, risking pressure areas and damage to neurovascular structures. There have been no studies showing the clinical results of the use of a bone anchor to secure the tendon without drilling through the lateral cuneiform. This study presents the largest series of outcomes for such a procedure. Retrospective case series. Electronic records for all children under 18 undergoing TATT with anchor fixation included. Outcomes recorded were a failure of the tendon transfer and complications. Seventy-seven feet were identified in 61 children with a male-to-female ratio of 2.5:1, the average age at surgery of 5.6 years, and an average follow-up of 4.4 years. There were no cases of pullout of the anchor. Seventy-six cases (98.7%) had no recurrence of dynamic supination on follow-up. No revision surgery was required. Consistently reliable, reproducible and safe fixation of the tibialis anterior tendon in TATT can be achieved using a bone anchor for the treatment of dynamic supination in children with clubfeet following correction using the Ponseti method and is a quick and straightforward alternative method to traditional techniques.