PONSETI PROTOCOL FOR RELAPSE AFTER POSTEROMEDIAL RELEASE (PMR). IS IT AN OPTIMAL AND PERDURABLE OPTION FOR THIS CHALLENGING COMPLICATION? Dra. Anna Ey Batlle, Dra. Imma Vilalta Vidal, Dra. Melisa Stitzman Wengrowicz, Dr. Norberto Ventura Gómez, Hospital Sant Joan de Déu-Barcelona (SPAIN)
RELAZIONE DELLA DOTT.SSA ANNA EY BATLLE
Scientific session: Club-foot
Ponseti protocol for relapse after posteromedial release
(Pmr). Is it an optimal and durable option
for this challenging complication?
Ana Maria Ey Batlle, Imma Vilalta Vidal, Melisa Stitzman, Norberto Ventura Gomez,Hospital Sant Joan de Deu, Esplugues (Barcelona), Spain
Hospital Sant Joan de Deu, Esplugues(Barcelona), Spain
Introduction: The application of Ponseti Protocol in PMR relapses was presented for the first time in Sorrento EPOS 2007, and published in CORR in 2009 as a multricentic study. The efficacy of this protocol 123 J Child Orthop (2015) 9 (Suppl 1):S11–S56 DOI 10.1007/s11832-015-0637-0 was proved, but the perdurability of the results at midterm follow-up wasn´t.
Aim: To evaluate the outcome and follow-up of this treatment for PMR relapses.
Materials and methods: All patients have been treated with the Ponseti Protocol for relapse of previous treatment. We excluded patients younger than 3 year, neurological feet, arthrogrypotic and just Posterior release.
Protocol: Cast to 40o abduction +anterior tibial tendon transfer(ATTT) with titanium anchor ± Achilles tenotomy ± plantar fasciotomy.
Results: A total of 48 patients with 71 feet were included, 29 male, 19 female. Age 3.2–15 year (average 7.61). The number of previous surgeries: 56 feet had 1 PMR, 12 feet 2 PMR, 3 feet 3 PMR, 7 feet had other added surgeries. All were proposed for another PMR or bone surgery. Previous casting: None in 15 feet, 1 cast in 33 feet 2 casts in 16 feet, 3 in 5 feet, 4 in 2 feet had associated surgeries to ATTT: 70 feet Achilles tenotomy, 67 feet fasciotomy, 2 feet Jones procedure, 1 foot calcaneal osteotomy, 1 foot first metatarsal osteotomy, 4 feet replacement of previous hemi-transfer.
Complications: 4 superficial infections Re-relapses: 1 foot due to the loosening of the anchor (1.4 %) 10 feet needed repeated Achilles tenotomy because of equinus relapse (14 %). Functional results at last follow-up: dorsiflexion before treatment: average -13 (range -35 to +20) Post-transfer: average 11.5 (range -15 to +30) Pain: 2 feet in the same patient had morning pain. Activities: 5 feet daily activity limitations, 51 feet practice sports Laaveg Ponseti Score average 78 (88 max–56 min) (average in 2009 : 72)
Conclusions: The Ponseti Protocol is effective in PMR relapses. The results are manteined at mid-term follow-up. There is a risk of equinus relapse that needs re-tenotomy (14 %).