Haile Alazar M, Ayana Birhanu, Mekonnen Wubegzier, Bantigegn Fentahun, Amanu Bizuayehu
Tikur Anbessa Specialized Hospital, Department of Orthopaedics, College of Health Sciences, Addis Ababa University, Ethiopia.
Tikur Anbessa Specialized Hospital, Department of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia.
J Pediatr Soc North Am. 2025 Mar 19;11:100182. doi: 10.1016/j.jposna.2025.100182. eCollection 2025 May.
Tibialis anterior tendon transfer (TATT) is a surgical procedure aimed at correcting dynamic supination in children with idiopathic clubfoot, typically performed between ages 2.5 and 5. There is limited literature discussing the factors that contribute to unfavorable outcomes. This study explores the clinical and functional outcomes of TATT and identifies factors that lead to poor functional results.
This retrospective cohort study evaluated children with recurrent idiopathic clubfoot who underwent TATT from February 2021 to February 2024 in Tikur Anbessa Specialized Hospital, Ethiopia. A matched comparison group that did not undergo TATT was used, with a final sample of 42 TATT patients (56 feet) and 21 non-surgery patients (36 feet). For cases involving both feet, the outcome scores were averaged. Data were collected using the Oxford Foot Ankle Questionnaire and Pirani/Bohm/Sinclair scores via interviews and clinical evaluations, with analysis performed using the R package vcd (R Core Team, 2024).
Sixty-three cases (92 feet) were analyzed. The TATT group showed significantly better clinical ( = .02) and functional scores ( = .006). However, a low correlation was observed between clinical measures and patient-reported outcomes (τ = 0.22, = .018). Patients with poor brace compliance and structural deformities (varus/equinus) showed inferior patient-reported outcomes on the bivariate regression. A progressive decline in patient-reported outcomes was also noted with advancing patient age at the time of surgery. In multivariate analysis, structural deformities-namely varus ( = .012) and equinus ( < .001)-were significantly related to poor functional outcomes.
The TATT group exhibited higher clinical (12.3%) and functional (11.8%) scores compared with the non-TATT group, indicating better outcomes. The low correlation between the two outcome scores (τ = 0.22, = .018) underscores the importance of a comprehensive patient evaluation prior to surgery. Furthermore, unaddressed concomitant structural deformities, such as varus ( = .012) and equinus ( < .001), were linked to poorer functional outcomes when compared with cases that experienced a recurrence of dynamic supination after TATT ( = .8).
(1)The Ponseti method, which involves serial manipulation and casting, is considered the gold standard for the initial management of idiopathic clubfoot.(2)Approximately one-third of clubfoot cases treated successfully experience a recurrence, often presenting as dynamic supination.(3)For children over the age of three, tibialis anterior tendon transfer is recommended to address dynamic supination.(4)Clinician assessment of the need for the procedure does not always correlate with patient perception of functional impairment.(5)Limited published data suggest that there are significant rates of secondary recurrence even after successful tendon transfer.
Level III.
胫前肌腱转移术（TATT）是一种旨在纠正特发性马蹄内翻足患儿动态旋后畸形的外科手术，通常在2.5至5岁之间进行。关于导致不良预后因素的文献有限。本研究探讨了胫前肌腱转移术的临床和功能结果，并确定导致功能结果不佳的因素。
这项回顾性队列研究评估了2021年2月至2024年2月在埃塞俄比亚提库尔·安贝萨专科医院接受胫前肌腱转移术的复发性特发性马蹄内翻足患儿。使用未接受胫前肌腱转移术的匹配对照组，最终样本包括42例接受胫前肌腱转移术的患者（56只脚）和21例非手术患者（36只脚）。对于涉及双脚的病例，将结果评分进行平均。通过访谈和临床评估，使用牛津足踝问卷和皮拉尼/博姆/辛克莱评分收集数据，使用R包vcd（R核心团队，2024）进行分析。
分析了63例（92只脚）。胫前肌腱转移术组的临床（P = 0.02）和功能评分（P = 0.006）明显更好。然而，临床测量与患者报告的结果之间观察到低相关性（τ = 0.22，P = 0.018）。支具依从性差和存在结构性畸形（内翻/马蹄）的患者在双变量回归中患者报告的结果较差。还注意到随着手术时患者年龄的增加，患者报告的结果逐渐下降。在多变量分析中，结构性畸形——即内翻（P = 0.012）和马蹄（P < 0.001）——与不良功能结果显著相关。
与未接受胫前肌腱转移术的组相比，胫前肌腱转移术组的临床（12.3%）和功能（11.8%）评分更高，表明预后更好。两个结果评分之间的低相关性（τ = 0.22，P = 0.018）强调了手术前全面评估患者的重要性。此外，与胫前肌腱转移术后动态旋后复发的病例相比（P = 0.8），未解决的伴随结构性畸形，如内翻（P = 0.012）和马蹄（P < 0.001），与较差的功能结果相关。
（1）涉及系列手法复位和石膏固定的庞塞蒂方法被认为是特发性马蹄内翻足初始治疗的金标准。（2）约三分之一成功治疗的马蹄内翻足病例会复发，通常表现为动态旋后。（3）对于三岁以上的儿童，建议进行胫前肌腱转移术以解决动态旋后问题。（4）临床医生对手术必要性的评估并不总是与患者对功能障碍的感知相关。（5）有限的已发表数据表明，即使肌腱转移成功，二次复发率也很高。
三级。
