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Johansson A, Wallander H, Esbjörnsson AC. Initial clubfoot treatment in Sweden from 2016 to 2019: A national register study. PLoS One 2024; 19:e0305900. [PMID: 38924021 PMCID: PMC11207129 DOI: 10.1371/journal.pone.0305900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND This study aimed to describe the initial treatment of clubfoot deformity in Sweden using a national cohort. Secondarily we aimed to analyse the results of the initial treatment in relation to foot severity and additional diseases. METHODS A national register, the Swedish Pediatric Orthopedic Quality Register, was used to extract data on children born with clubfoot in 2016-2019. Children with a registered evaluation after initial treatment were included. Data on deformity severity (Pirani score), casting treatment, and achillotenotomy were extracted. For children with bilateral clubfeet, one foot was included in the analysis. RESULTS A total of 565 children were included in the analysis. Of these, 73% were boys and 47% had bilateral clubfeet. Children with isolated clubfoot required a median of six casts to correct the deformity, while children with non-isolated clubfoot needed a median of eight casts. Seventy-seven percent underwent an achillotenotomy. Residual deformities of 0.5 or above (often soft-tissue issues) according to the Pirani score were noted in 23% (isolated clubfoot) and 61% (non-isolated clubfoot) after initial treatment. CONCLUSIONS We have described the initial clubfoot treatment of children born with isolated or non-isolated clubfoot in Sweden based on data from a national register. The initial treatment was performed to a large extent according to the Ponseti method and international recommendations. Moreover, we discuss the usefulness of the Pirani score in classifying clubfoot deformity after treatment.
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Affiliation(s)
- Arne Johansson
- Department of Orthopaedics, Skaraborg Hospital, Skövde, Sweden
| | - Henrik Wallander
- Departments of Orthopedic Surgery, Gävle Hospital, Gävle, Sweden
| | - Anna-Clara Esbjörnsson
- Department of Clinical Sciences Lund, Orthopaedics, Skane University Hospital, Lund University, Lund, Sweden
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Naili JE, Lindeberg M, Esbjörnsson AC. Duration and outcome of orthotic treatment in children with clubfoot - a four-year follow-up national register study of Swedish children born between 2015 and 2017. BMC Musculoskelet Disord 2024; 25:425. [PMID: 38822269 PMCID: PMC11143618 DOI: 10.1186/s12891-024-07544-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The Ponseti method for treating clubfoot consists of initial treatment with serial casting accompanied by achillotenotomy if needed, followed by the maintenance phase including treatment with a foot abduction orthosis (FAO) for at least four years. This study aimed to examine the duration, course, and outcome of orthotic treatment in children with clubfoot. METHODS 321 children with clubfoot, born between 2015 and 2017, registered in the Swedish Pediatric Orthopedic Quality Register (SPOQ), were included in this prospective cohort study. Data on deformity characteristics and orthotic treatment were extracted. For children with bilateral clubfoot, one foot was included in the analysis. RESULTS Of the 288 children with isolated clubfoot, 274 children (95.5%) were prescribed an FAO, and 100 children (35%) changed orthosis type before 4 years of age. Of the 33 children with non-isolated clubfoot, 25 children (76%) were prescribed an FAO, and 21 children (64%) changed orthosis type before 4 years of age. 220 children with isolated clubfoot (76%), and 28 children with non-isolated clubfoot (84%) continued orthotic treatment until 4 years of age or longer. Among children with isolated clubfoot, children ending orthotic treatment before 4 years of age (n = 63) had lower Pirani scores at birth compared to children ending orthotic treatment at/after 4 years of age (n = 219) (p = 0.01). It was more common to change orthosis type among children ending orthotic treatment before 4 years of age (p = 0.031). CONCLUSIONS The majority of children with clubfoot in Sweden are treated with an FAO during the maintenance phase. The proportion of children changing orthosis type was significantly greater and the Pirani score at diagnosis was lower significantly among children ending orthotic treatment before 4 years of age. Long-term follow-up studies are warranted to fully understand how to optimize, and individualize, orthotic treatment with respect to foot involvement and severity of deformity. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Josefine Eriksson Naili
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
- Motion Analysis Lab, Karolinska University Hospital, Stockholm, Sweden.
| | - Malin Lindeberg
- Department of Orthopedics, Skane University Hospital, Lund, Sweden
| | - Anna-Clara Esbjörnsson
- Department of Clinical Sciences and Infectious Diseases, Skane University Hospital, Lund University, Lund, Sweden
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Rethlefsen SA, Hanson A, Ciccodicola E, Hara R, Kay RM, Chambers H, Wren TAL. Update on the reliability of gait analysis interpretation in cerebral palsy: Inter-institution agreement. Gait Posture 2024; 109:109-114. [PMID: 38295485 DOI: 10.1016/j.gaitpost.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/26/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Studies have shown good reliability for gait analysis interpretation among surgeons from the same institution. However, reliability among surgeons from different institutions remains to be determined. RESEARCH QUESTION Is gait analysis interpretation by surgeons from different institutions as reliable as it is for surgeons from the same institution? METHODS Gait analysis data for 67 patients with cerebral palsy (CP) were reviewed prospectively by two orthopedic surgeons from different institutions in the same state, each with > 10 years' experience interpreting gait analysis data. The surgeons identified gait problems and made treatment recommendations for each patient using a rating form. Percent agreement between raters was calculated for each problem and treatment, and compared to expected agreement based on chance using Cohen's kappa. RESULTS For problem identification, the greatest agreement was seen for equinus (85% agreement), calcaneus (88%), in-toeing (89%), and out-toeing (90%). Agreement for the remaining problems ranged between 66-78%. Percent agreement was significantly higher than expected due to chance for all issues (p ≤ 0.01) with modest kappa values ranging from 0.12 to 0.51. Agreement between surgeons for treatment recommendations was highest for triceps surae lengthening (89% agreement), tibial derotation osteotomy (90%), and foot osteotomy (87%). Agreement for the remaining treatments ranged between 72-78%. Percent agreement for all treatments was significantly higher than the expected values (p ≤ 0.002) with modest kappa values ranging from 0.22 to 0.52. SIGNIFICANCE Previous research established that computerized gait analysis data interpretation is reliable for surgeons within a single institution. The current study demonstrates that gait analysis interpretation can also be reliable among surgeons from different institutions. Future research should examine reliability among physicians from more institutions to confirm these results.
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Affiliation(s)
- Susan A Rethlefsen
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA.
| | - Alison Hanson
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Eva Ciccodicola
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Reiko Hara
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Robert M Kay
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Hank Chambers
- Rady Children's Hospital, 3030 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Tishya A L Wren
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
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Ayeni OR. Defining hip cartilage repair: a modified delphi study to establish the Magnetic Resonance Evaluation of the Repair of Cartilage in the Hip (MERCH) score. J Exp Orthop 2023; 10:129. [PMID: 38051413 DOI: 10.1186/s40634-023-00676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023] Open
Abstract
PURPOSE To develop a standardized scoring system to evaluate pre- to post-operative repair or reconstruction of hip cartilage using magnetic resonance imaging (MRI). METHODS A two-phase modified Delphi study was conducted. Phase 1 involved a survey with suggested criteria and diagrams to define various stages of articular cartilage repair and phase 2 involved an expert consensus meeting that discussed the survey responses and voted on final scoring criteria. The survey was emailed to members of the Canadian Hip Preservation Research Collaborative (CHIPR) and respondents included both board certified orthopedic surgeons as well as musculoskeletal radiologists. RESULTS Overall, there were 17 survey respondents from Canada and most (47%, 8/17) participants agreed that the minimum MRI protocol needed to evaluate cartilage repair was a 3.0 T MRI and 94% (17/18) agreed that the minimum time post-operatively that they felt they would be able to accurately evaluate cartilage repair on an MRI was 12 months. Following phases 1 and 2, the final Magnetic Resonance Evaluation of the Repair of Cartilage in the Hip (MERCH) score was developed with 7 domains, 3 criteria per domain: 1) volume fill of cartilage defect, 2) integration into adjacent cartilage, 3) surface of the repair tissue, 4) structure of the repair tissue, 5) bony overgrowth, 6) subchondral changes, and 7) delamination. The score ranges from 60 (optimal) to -20 points (worst/none). CONCLUSIONS This consensus project established a new MRI scoring system to evaluate post-operative cartilage restoration of the hip. The implementation of the MERCH score is essential in our ability to guide patient management and expectations in a rapidly evolving field and will help with standardizing our evaluation of cartilage repair in future research trials. LEVEL OF EVIDENCE Level II Diagnostic.
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Affiliation(s)
- Olufemi R Ayeni
- McMaster University Medical Centre, Hamilton, 1200 Main St West, 4E15, ON, L8N 3Z5, Canada.
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Factors Predictive of Tenotomy After Ponseti Casting for Idiopathic Clubfoot: A Tertiary Care Center Study. J Pediatr Orthop 2023; 43:174-176. [PMID: 36728662 DOI: 10.1097/bpo.0000000000002338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Parents of children with clubfoot are likely to inquire about the need for tenotomy and about any factors that may be predictive. The present study was done to identify factors that may help predict the need for tenotomy in children undergoing Ponseti treatment for idiopathic clubfoot. METHODS A prospective observational study was conducted on patients under 5 years of age with idiopathic clubfoot and no previous treatment history treated at Hospital and Rehabilitation Centre for Disabled Children. The relationship between the Pirani score, Dimeglio score, age, and passive ankle dorsiflexion (DF) and the need for heel cord tenotomy was analyzed using appropriate statistical methods. RESULTS Of 83 patients (125 feet) with a mean age of 6 months, 93 feet (74.4%) required a percutaneous tenotomy. The mean initial Pirani and Dimeglio score for 125 club feet was 4.5 (SD=1.68) and 13.5 (SD=6.1), respectively. The mean initial passive ankle DF was -40.4 (SD=22.31). The Dimeglio ( P =0.000), Pirani scores ( P =0 .000), and passive ankle DF ( P =0.000) showed significant association with the need for tenotomy. CONCLUSIONS This study shows a strong association between initial Pirani and Demiglio scores and initial passive ankle DF as predictive of a heel cord tenotomy. However, age, sex, and laterality were not associated with the need for tenotomy.
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Eight-year Review of a Clubfoot Treatment Program in Pakistan With Assessment of Outcomes Using the Ponseti Technique: A Retrospective Study of 988 Patients (1,458 Clubfeet) Aged 0 to 5 Years at Enrollment. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00019. [PMID: 35467578 PMCID: PMC9042583 DOI: 10.5435/jaaosglobal-d-22-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/19/2022] [Indexed: 11/18/2022]
Abstract
To conduct an 8-year retrospective review of a clubfoot treatment program using the Ponseti technique with close monitoring of outcomes.
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Esbjörnsson AC, Johansson A, Andriesse H, Wallander H. Epidemiology of clubfoot in Sweden from 2016 to 2019: A national register study. PLoS One 2021; 16:e0260336. [PMID: 34855788 PMCID: PMC8638957 DOI: 10.1371/journal.pone.0260336] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to estimate the birth prevalence of children born with isolated or non-isolated clubfoot in Sweden using a national clubfoot register. Secondarily we aimed to describe the clubfoot population with respect to sex, laterality, severity of deformity, comorbidity and geographic location. METHODS A national register, the Swedish Pediatric Orthopedic Quality register, was used to extract data on newborn children with clubfoot. To calculate the birth prevalence of children with isolated or non-isolated clubfoot between 1st of January 2016 and 31st of December 2019, we used official reports of the total number of Swedish live births from the Swedish Board of Statistics. The Pirani score and predefined signs of atypical clubfoot were used to classify clubfoot severity at birth. RESULTS In total 612 children with clubfoot were identified. Of these, 564 were children with isolated clubfoot, generating a birth prevalence of 1.24/1000 live births (95% confidence interval 1.15-1.35). About 8% were children with non-isolated clubfoot, increasing the birth prevalence to 1.35/1000 live births (95% confidence interval 1.25-1.46). Of the children with isolated clubfoot, 74% were boys and 47% had bilateral involvement. The children with non-isolated clubfoot had more severe foot deformities at birth and a greater proportion of clubfeet with atypical signs compared with children with isolated clubfoot. CONCLUSION We have established the birth prevalence of children born with isolated or non-isolated clubfoot in Sweden based on data from a national register. Moreover, we have estimated the number of children born with atypical clubfeet in instances of both isolated and non-isolated clubfoot. These numbers may serve as a baseline for expected birth prevalence when planning clubfoot treatment and when evaluating time trends of children born with clubfoot.
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Affiliation(s)
- Anna-Clara Esbjörnsson
- Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Orthopaedics, Lund, Sweden
| | - Arne Johansson
- Department of Orthopaedics, Skaraborg Hospital, Skövde, Sweden
| | - Hanneke Andriesse
- Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Orthopaedics, Lund, Sweden
| | - Henrik Wallander
- Departments of Orthopedic Surgery, Gävle Hospital, Gävle, Sweden
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Pavone V, Vescio A, Culmone A, Caldaci A, Rosa PL, Costarella L, Testa G. Interobserver Reliability of Pirani and Dimeglio Scores in the Clinical Evaluation of Idiopathic Congenital Clubfoot. CHILDREN-BASEL 2021; 8:children8080618. [PMID: 34438509 PMCID: PMC8392791 DOI: 10.3390/children8080618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dimeglio (DimS) and Pirani (PirS) scores are the most common scores used in congenital talipes equinovarus (CTEV) clinical practice. The aim of this study was to evaluate the interobserver reliability of these scores and how clinical practice can influence the clinical outcome of clubfoot through the DimS and Pirs. METHODS Fifty-four feet were assessed by six trained independent observers through the DimS and PirS: three consultants (OS), and three residents (RS) divided into three pediatric orthopaedic surgeons (PeO) and three non-pediatric orthopaedic surgeons (NPeO). RESULTS The PirS and DimS Scores were strongly correlated. In the same way, OS and RS, PirS, and DimS scores were strongly correlated, and the interobserver reliability ranked "good" in the comparison between PeO and NPeO. In fully trained paediatric orthopaedic surgeons, an "excellent" interobserver reliability was found but was only "good" in the NPeO cohort. CONCLUSIONS In conclusion, after careful preparation, at least six months of observation of children with CTEV, PirS and DimS proved to be valid in terms of clinical evaluation. However, more experience with CTEV leads to a better clinical evaluation.
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