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1.
Arthroscopy ; 36(9): 2510-2512, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891251

RESUMO

The medial patellofemoral complex, composed predominantly of the medial patellofemoral ligament, plays an important role in patellar tracking and stability. Medial patellofemoral ligament reconstruction is accordingly one of the most broadly applied surgical techniques for treating patellar instability. Orthopaedic research has demonstrated that surgeries that restore native anatomy are often more effective. The medial patellotibial ligament clearly serves an important supporting role in patellar tracking and stability, particularly in early flexion, and its inclusion in medial soft-tissue reconstructions more closely restores native patella tracking. Whether reconstructions incorporating the medial patellotibial ligament will translate to improved outcomes remains unclear.


Assuntos
Luxação Patelar , Articulação Patelofemoral , Fenômenos Biomecânicos , Humanos , Ligamentos Articulares , Patela
2.
Zhongguo Gu Shang ; 33(8): 703-6, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875757

RESUMO

OBJECTIVE: To explore the clinical effect of the modified double Endobutton technique combined with Nice node in the treatment of Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation. METHODS: From March 2016 to January 2019, 23 patients with Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation were treated with modified double Endobutton technique to reconstruct coracoclavicular ligament and Nice node to repair acromioclavicular ligament, including 18 males and 5 females, aged 31 to 53 (43.2±5.4) years, 9 on the left and 14 on the right, and the time from injury to operation was 1 to 10 days. Before operation, X-ray films and CT three-dimensional reconstruction of bilateral shoulder joint were performed. Postoperative complications were observed. Six months after operation, DASHand Constant-Murley scores were used to evaluate the treatment effect. RESULTS: The incision healed in one stage after operation, and no complications such as vascular and nerve injury and stress fracture occurred. All patients were followed up for 6 to 24 (12.0±4.9) months. At 6 months follow-up, the DASH score was 0.40±0.10 lower than that of 19.80±4.50 before operation, and the Constant-Murley score was 94.20±4.20 higher than that of 38.60±3.90 before operation. CONCLUSION: The treatment of Rockwood Ⅲ-Ⅴ dislocation of acromioclavicular joint with double Endobutton technique and nice knot is satisfactory in the early stage. The long-term effect and complications need further follow-up.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Luxação do Ombro , Adulto , Feminino , Humanos , Ligamentos Articulares , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Zhongguo Gu Shang ; 33(8): 745-9, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875766

RESUMO

OBJECTIVE: To explore the safety of classic Acupotomy in the treatment of carpal tunnel syndrome. METHODS: Twenty six adult specimens (15 males and 11 females), aged 60 to 95(82.54±6.94) years old, were selected from 10% formalin antiseptic fixation. There were 52 sides(two of them could not be tested). The study period was from November 2017 to May 2018. The specimens were collected from the body donation center of the school of basic medicine, Peking University. The operation of releasing the transverse carpal ligament on the human body specimen was simulated by the classic acupotomy, and the distance from the four points to the surrounding anatomical structure was measured to calculate the direct injury rate to the nerve and blood vessels, and the shortest distance between the acupotomy and the nerve and blood vessels was defined as ≥2 mm as safety. RESULTS: In the experimental operation, the direct injury rate of nerve and blood vessel was 14% and 12% respectively. There was significant difference in the rate of direct nerve injury between the four injection points (P<0.05). There was no significant difference in the rate of direct vascular injury between the four injection points (P>0.05). Among the four points, there was a statistically significant difference in the safety of nerves(P<0.05), and the safety of point 1 and point 3 of radial injection was higher than that of point 2 and point 4 of ulnar injection(P<0.05). There was significant difference in the safety of blood vessels between the four points(P<0.05), and the safety of radial point 1 was higher than that of ulnar point 2 and point 4 (P<0.05). CONCLUSION: The safety of the classic Acupotomy for carpal tunnel syndrome is related to the location of the needle entry point, and the safety of theradial proximal end of the needle is the highest.


Assuntos
Terapia por Acupuntura , Síndrome do Túnel Carpal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ligamentos Articulares , Masculino , Nervo Mediano/lesões , Pessoa de Meia-Idade , Agulhas , Articulação do Punho
4.
Arthroscopy ; 36(8): 2246-2248, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747065

RESUMO

Trochleoplasty in patellofemoral instability has always been controversial. Most authors recognize the fundamental role of trochlear dysplasia in the genesis of patellar dislocation, and some strongly defend correcting the abnormality, yet others find it too dangerous or unnecessary. Misunderstanding or undervaluation of trochlear dysplasia leads to inappropriate or failed patellofemoral (PF) surgery, the iatrogenic complications of which are well known. Many surgeons miss a key aspect of trochlear dysplasia: the overhang or the prominence of the trochlea relative to the anterior femoral cortex, characterized by a supra-trochlear spur. Trochleoplasty should not be performed as a secondary or revision procedure, but as a primary procedure with clear indications, and the key to improved outcomes is to ensure the right indication for each patient, which can only be determined by understanding the extent of dysplasia in both the axial and sagittal planes.


Assuntos
Luxação Patelar , Cirurgiões , Fêmur , Humanos , Articulação do Joelho , Ligamentos Articulares
5.
Bone Joint J ; 102-B(7): 918-924, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600145

RESUMO

AIMS: There is a lack of long-term data for minimally invasive acromioclavicular (AC) joint repair. Furthermore, it is not clear if good early clinical results can be maintained over time. The purpose of this study was to report long-term results of minimally invasive AC joint reconstruction (MINAR) and compare it to corresponding short-term data. METHODS: We assessed patients with a follow-up of at least five years after minimally invasive flip-button repair for high-grade AC joint dislocation. The clinical outcome was evaluated using the Constant score and a questionnaire. Ultrasound determined the coracoclavicular (CC) distance. Results of the current follow-up were compared to the short-term results of the same cohort. RESULTS: A total of 50 patients (three females, 47 males) were successfully followed up for a minimum of five years. The mean follow-up was 7.7 years (63 months to 132 months). The overall Constant score was 94.4 points (54 to 100) versus 97.7 points (83 to 100) for the contralateral side showing a significant difference for the operated shoulder (p = 0.013) The mean difference in the CC distance between the operated and the contralateral shoulder was 3.7 mm (0.2 to 7.8; p = 0.010). In total, 16% (n = 8) of patients showed recurrent instability. All these cases were performed within the first 16 months after introduction of this technique. A total of 84% (n = 42) of the patients were able to return to their previous occupations and sport activities. Comparison of short-term and long-term results revealed no significant difference for the Constant Score (p = 0.348) and the CC distance (p = 0.974). CONCLUSION: The clinical outcome of MINAR is good to excellent after long-term follow-up and no significant differences were found compared to short-term results. We therefore suggest this is a reliable technique for surgical treatment of high-grade AC joint dislocation. Cite this article: Bone Joint J 2020;102-B(7):918-924.


Assuntos
Articulação Acromioclavicular/cirurgia , Ligamentos Articulares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Luxação do Ombro/cirurgia , Articulação Acromioclavicular/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Ligamentos Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Luxação do Ombro/diagnóstico por imagem , Ultrassonografia/métodos
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(7): 836-842, 2020 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-32666725

RESUMO

Objective: To observe the effectiveness of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity for the treatment of recurrent dislocation of patella. Methods: Retrospectively analyse the clinical data of 24 patients (24 knees) with recurrent patellar dislocation with tibial tuberosity-trochlear groove distance (TT-TG) values more than 15 mm who were admitted between September 2014 and September 2018. Of which 7 were male and 17 were female; aged 16-35 years old with an average of 25.8 years. The disease duration ranged from 15 to 46 months, with an average of 26.7 months. All patients had a history of knee trauma, and a positive result of apprehension test on the affected knee. All patients underwent the surgery of arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity. Before and after operation, Kujala score was used to evaluate patellofemoral joint function, Lysholm score was used to evaluate knee joint function; CT and MRI were used to measure and compare the changes of congruence angle (CA), patellar tilt angle (PTA), and lateral patella displacement (LPD) in order to evaluate patella stability. Results: All incisions healed by first intention, and no infection or neurovascular injury occurred. Deep vein thrombosis of the lower extremities occurred in 2 cases at 4 and 7 days after operation respectively, and the thrombosis disappeared after symptomatic treatment. All the 24 patients were followed up 12-14 months (mean, 12.9 months). During follow-up, no patellar dislocation reoccurred in the affected knee. At last follow-up, the apprehension test was negative in every patients. The TT-TG, CA, PTA, and LPD were significantly improved when compared with those before operation ( P<0.05). The Kujala score and Lysholm score at 1 month and last follow-up were significantly better than those before operation, and the above scores at last follow-up were significantly better than those at 1 month after operation ( P<0.05). According to Lysholm score, the patients' knee joint functions were excellent in 13 cases, good in 10 cases, and fair in 1 case, and the excellent and good rate was 95.8%. Conclusion: Arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon combined with medial displacement of lateral hemitibial tuberosity has the advantages of minimal invision and reliable effectiveness. It can be used as one of the effective surgical methods for the treatment of recurrent dislocation of patella.


Assuntos
Luxação Patelar , Articulação Patelofemoral , Adolescente , Adulto , Feminino , Humanos , Articulação do Joelho , Ligamentos Articulares , Masculino , Patela , Estudos Retrospectivos , Adulto Jovem
7.
Medicine (Baltimore) ; 99(25): e20818, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569230

RESUMO

RATIONALE: Stylohyoid complex syndrome is characterized by various cervicopharyngeal symptoms related to the ossification and abnormality of the styloid process, stylohyoid ligament, and the lesser horn of the hyoid bone. Eagle syndrome is the most well-known of the spectra of these diseases. Although surgical treatment is considered effective, conservative treatment may be beneficial if symptoms arise because of inflammation of the soft tissues attached to the styloid process or hyoid bone. PATIENT CONCERNS: A 68-year-old man presented with pain in the right side of the neck and odynophagia after trauma on his philtrum. He was diagnosed with Eagle syndrome elicited by a fracture from indirect trauma. Despite analgesic medication and physiotherapy, the pain had somewhat relieved but persisted for 1 year. DIAGNOSIS: Computed tomography revealed complete ossification of the bilateral stylohyoid complex. A fracture was observed in the ampulla on the right side of the neck. One year later, the fracture resolved by complete union. INTERVENTIONS: Ultrasonography was performed and abnormal ossification was observed on the right side of the neck. Five milligrams of dexamethasone at a concentration of 1 kg/m was slowly injected into the tender point under ultrasonographic guidance. OUTCOMES: The patient reported immediate reduction of pain and was satisfied with the resolution. No recurrence was observed during a 6-month follow-up period. LESSONS: Although traumatic fracture of the ossified ligament elicited the syndrome, the results were satisfactory because the origin of the patient's pain was presumed to arise from inflammatory conditions. This case demonstrates that treatment with local steroid injection may be appropriate for patients who present with pain originating from muscles and ligaments.


Assuntos
Dexametasona/uso terapêutico , Fraturas Ósseas/complicações , Osso Hioide/lesões , Ligamentos Articulares/lesões , Ossificação Heterotópica/diagnóstico , Osso Temporal/anormalidades , Idoso , Dexametasona/administração & dosagem , Humanos , Ligamentos Articulares/patologia , Masculino , Ossificação Heterotópica/tratamento farmacológico , Ossificação Heterotópica/etiologia
10.
Arthroscopy ; 36(6): 1677-1678, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32503777

RESUMO

Given different functions of the medial quadriceps tendon-femoral ligament and medial patellofemoral ligament components of the proximal medial patellar restraints, reconstructions to the midpoint of the medial patellofemoral ligament and medial quadriceps tendon-femoral ligament are probably optimal, combining the benefits of both in surgical treatment of recurrent patella instability.


Assuntos
Patela , Articulação Patelofemoral , Articulação do Joelho , Ligamentos Articulares , Músculo Quadríceps
11.
Arthroscopy ; 36(6): 1735-1737, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32503781

RESUMO

The role of medial patellofemoral ligament (MPFL) repair versus reconstruction in the treatment of patellar instability continues to undergo debate. Repair of the ligament can be technically less demanding with fewer risks of morbidity, whereas reconstruction carries concerns of graft malpositioning or over-tensioning as well as the risk of patellar fracture. Studies directly comparing the 2 procedures in the setting of recurrent patellar instability have consisted of small series or low levels of evidence that inevitably include patients with concurrent morphologic risk factors such as tuberosity malalignment or patella alta, which are known factors that can influence the biomechanical behavior of the MPFL. Heterogeneity in patient-related risk factors and surgical techniques continues to pose limitations in allowing for direct comparisons between procedures. For the treatment of recurrent patellar instability in the setting of no (or concurrently addressed) morphologic abnormalities, MPFL reconstruction has become a common procedure and generally preferred approach. The superior outcomes associated with reconstruction over repair, however, should be qualified with the fact that attention to the critical details of the technique, including graft position and tension, is paramount to success when performing this procedure.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Articulação do Joelho , Ligamentos Articulares , Patela
12.
Bone Joint J ; 102-B(6_Supple_A): 59-65, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475273

RESUMO

AIMS: The removal of the cruciate ligaments in total knee arthroplasty (TKA) has been suggested as a potential contributing factor to patient dissatisfaction, due to alteration of the in vivo biomechanics of the knee. Bicruciate retaining (BCR) TKA allows the preservation of the cruciate ligaments, thus offering the potential to reproduce healthy kinematics. The aim of this study was to compare in vivo kinematics between the operated and contralateral knee in patients who have undergone TKA with a contemporary BCR design. METHODS: A total of 29 patients who underwent unilateral BCR TKA were evaluated during single-leg deep lunges and sit-to-stand tests using a validated computer tomography and fluoroscopic imaging system. In vivo six-degrees of freedom (6DOF) kinematics were compared between the BCR TKA and the contralateral knee. RESULTS: During single-leg deep lunge, BCR TKAs showed significantly less mean posterior femoral translation (13 mm; standard deviation (SD) 4) during terminal flexion, compared with the contralateral knee (16.6 mm, SD 3.7; p = 0.001). Similarly, BCR TKAs showed significantly less mean femoral rollback (11.6 mm (SD 4.5) vs 14.4 mm (SD 4.6); p < 0.043) during sit-to-stand. BCR TKAs showed significantly reduced internal rotation during many parts of the strenuous flexion activities particularly during high-flexion lunge (4° (SD 5.6°) vs 6.5° (SD 6.1°); p = 0.051) and during sit-to-stand (4.5° (SD 6°) vs 6.9° (SD 6.3°); p = 0.048). CONCLUSION: The contemporary design of BCR TKA showed asymmetrical flexion-extension and internal-external rotation, suggesting that the kinematics are not entirely reproduced during strenuous activities. Future studies are required to establish the importance of patient factors, component orientation and design, in optimizing kinematics in patients who undergo BCR TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):59-65.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Ligamentos Articulares , Tratamentos com Preservação do Órgão , Amplitude de Movimento Articular , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Resultado do Tratamento
13.
Orthopade ; 49(8): 733-736, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32518980

RESUMO

A 29-year-old physically active patient presented with recurrent right-sided patellar dislocation. Clinical and radiological investigation showed patellar instability with stable cruciate and collateral ligaments, excess internal rotation of the right femur, as well as trochlear dysplasia. Treatment consisted of trochleoplasty in combination with medial patellofemoral ligament reconstruction.


Assuntos
Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Humanos , Instabilidade Articular/diagnóstico por imagem , Articulação do Joelho , Masculino , Luxação Patelar/diagnóstico por imagem , Resultado do Tratamento
14.
Clin Sports Med ; 39(3): 637-655, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446580

RESUMO

This article is a brief overview of the elbow dislocations focusing on updates in treatment and rehabilitation protocols. The fight between obtaining elbow stability without leading to long-term elbow stiffness has been a continued focus in field of sports medicine. This article highlights advances made to help treat the injuries appropriately and obtain optimal patient outcomes.


Assuntos
Traumatismos em Atletas/terapia , Cotovelo/lesões , Luxações Articulares/terapia , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/cirurgia , Fratura-Luxação/fisiopatologia , Fratura-Luxação/cirurgia , Fratura-Luxação/terapia , Humanos , Luxações Articulares/fisiopatologia , Luxações Articulares/cirurgia , Ligamentos Articulares/lesões , Amplitude de Movimento Articular , Resultado do Tratamento
15.
Orthopade ; 49(7): 611-616, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32430549

RESUMO

BACKGROUND: Kinematic alignment means a surgical technique that focuses on intraarticular balance and laxity and takes into consideration the prearthritic state of the knee joint. AIM: The aim of kinematic alignment is a constitutionally aligned joint space line and balanced tension of the soft tissue covering. By avoiding the proximalization of the joint line and the release of the ligaments, the risk of destabilization of the original physiology of the joint is reduced. METHODS: After resections and recuts of the distal femur, a natural distal femoral joint line in full extension and the posterior line in 90° should be maintained or restored. Therefore, the flexion-extension axis of the femur, around which the knee joint moves, does not change. The principle of KA unequivocally requires the distal femoral cut to be performed before resection of the posterior femoral condyles. RESULTS: The result is a natural knee joint alignment that approximately replicates the anatomy of the femoral and tibial axes. Release of the ligaments is rarely required and all necessary adjustments are usually made using bone recuts.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Prótese do Joelho , Fenômenos Biomecânicos , Fêmur/cirurgia , Articulação do Joelho/fisiopatologia , Ligamentos Articulares/cirurgia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Tíbia/cirurgia , Resultado do Tratamento
16.
Arthroscopy ; 36(5): 1271-1272, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370889

RESUMO

More than 100 surgical techniques have been described for the reconstruction of the coracoclavicular ligament complex. None of the techniques appears superior, but double-button fixation for acute high-grade acromioclavicular dislocations has become an attractive option. The clinical outcomes are good to excellent, and the return to physical activity and sport is above 90%. However, complications such as loss of reduction and tunnel widening have been described and can reach up to 80%. The load to failure of the native coracoclavicular complex is more than 600 N, and any surgical technique must surpass this figure. Single-button and loop techniques do not always sufficiently stabilize the acromioclavicular joint. Even double- and triple-button techniques may not restore vertical and horizontal stability of the acromioclavicular joint to its native normal state. Double-button technique restores both scapula and clavicular rotation closest to the native state, but still has lower stiffness and results in higher superior-inferior translation, which could cause ongoing vertical instability.


Assuntos
Articulação Acromioclavicular , Luxação do Ombro , Clavícula , Humanos , Ligamentos Articulares , Escápula
17.
Arthroscopy ; 36(5): 1396-1397, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370901

RESUMO

While medial patellofemoral ligament reconstructions result in a high rate of return to sports, there is still a high reported complication rate. One area of controversy regarding the technique for the reconstruction is the knee flexion angle to use during graft fixation. Currently, more evidence is needed to determine whether there is a significant benefit to using a particular flexion angle during graft fixation.


Assuntos
Articulação do Joelho , Ligamentos Articulares , Fenômenos Biomecânicos , Cadáver , Humanos , Pressão , Suturas
18.
Cochrane Database Syst Rev ; 5: CD008602, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32412098

RESUMO

BACKGROUND: Congenital talipes equinovarus (CTEV), also known as clubfoot, is a common congenital orthopaedic condition characterised by an excessively turned-in foot (equinovarus) and high medial longitudinal arch (cavus). If left untreated it can result in long-term disability, deformity and pain. Interventions can be conservative (such as splinting or stretching) or surgical. Different treatments might be effective at different stages: at birth (initial presentation); when initial treatment does not work (resistant presentation); when the initial treatment works but the clubfoot returns (relapse/recurrent presentation); and when there has been no early treatment (neglected presentation). This is an update of a review first published in 2010 and last updated in 2014. OBJECTIVES: To assess the effects of any intervention for any type of CTEV in people of any age. SEARCH METHODS: On 28 May 2019, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL Plus, AMED and Physiotherapy Evidence Database. We also searched for ongoing trials in the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov (to May 2019). We checked the references of included studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs evaluating interventions for CTEV, including interventions compared to other interventions, sham intervention or no intervention. Participants were people of all ages with CTEV of either one or both feet. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the risks of bias in included trials and extracted the data. We contacted authors of included trials for missing information. We collected adverse event information from trials when it was available. When required we attempted to obtain individual patient data (IPD) from trial authors for re-analysis. If unit-of-analysis issues were present and IPD unavailable we did not report summary data, MAIN RESULTS: We identified 21 trials with 905 participants; seven trials were newly included for this update. Fourteen trials assessed initial cases of CTEV (560 participants), four trials assessed resistant cases (181 participants) and three trials assessed cases of unknown timing (153 participants). The use of different outcome measures prevented pooling of data for meta-analysis, even when interventions and participants were comparable. All trials displayed high or unclear risks of bias in three or more domains. Twenty trials provided data. Two trials reported on the primary outcome of function using a validated scale, but the data were not suitable for inclusion because of unit-of-analysis issues, as raw data were not available for re-analysis. We were able to analyse data on foot alignment (Pirani score), a secondary outcome, from three trials in participants at initial presentation. The Pirani score is a scale ranging from zero to six, where a higher score indicates a more severe foot. At initial presentation, one trial reported that the Ponseti technique significantly improved foot alignment compared to the Kite technique. After 10 weeks of serial casting, the average total Pirani score of the Ponseti group was 1.15 points lower than that of the Kite group (mean difference (MD) -1.15, 95% confidence interval (CI) -1.32 to -0.98; 60 feet; low-certainty evidence). A second trial found the Ponseti technique to be superior to a traditional technique, with mean total Pirani scores of the Ponseti participants 1.50 points lower than after serial casting and Achilles tenotomy (MD -1.50, 95% CI -2.28 to -0.72; 28 participants; very low-certainty evidence). One trial found evidence that there may be no difference between casting materials in the Ponseti technique, with semi-rigid fibreglass producing average total Pirani scores 0.46 points higher than plaster of Paris at the end of serial casting (95% CI -0.07 to 0.99; 30 participants; low-certainty evidence). We found no trials in relapsed or neglected cases of CTEV. A trial in which the type of presentation was not reported showed no evidence of a difference between an accelerated Ponseti and a standard Ponseti treatment in foot alignment. At the end of serial casting, the average total Pirani score in the accelerated group was 0.31 points higher than the standard group (95% CI -0.40 to 1.02; 40 participants; low-certainty evidence). No trial assessed gait using a validated assessment. Health-related quality of life was reported in some trials but data were not available for re-analysis. There is a lack of evidence for the addition of botulinum toxin A during the Ponseti technique, different types of major foot surgery or continuous passive motion treatment following major foot surgery. Most trials did not report on adverse events. Two trials found that further serial casting was more likely to correct relapse after Ponseti treatment than after the Kite technique, which more often required major surgery (risk differences 25% and 50%). In trials evaluating serial casting techniques, adverse events included cast slippage (needing replacement), plaster sores (pressure areas), and skin irritation. Adverse events following surgical procedures included infection and the need for skin grafting. AUTHORS' CONCLUSIONS: From the evidence available, the Ponseti technique may produce significantly better short-term foot alignment compared to the Kite technique. The certainty of evidence is too low for us to draw conclusions about the Ponseti technique compared to a traditional technique. An accelerated Ponseti technique may be as effective as a standard technique, but results are based on a single small comparative trial. When using the Ponseti technique semi-rigid fibreglass casting may be as effective as plaster of Paris. Relapse following the Kite technique more often led to major surgery compared to relapse following the Ponseti technique. We could draw no conclusions from other included trials because of the limited use of validated outcome measures and the unavailability of raw data. Future RCTs should address these issues.


Assuntos
Pé Torto Equinovaro/terapia , Toxinas Botulínicas Tipo A/uso terapêutico , Moldes Cirúrgicos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Ligamentos Articulares/cirurgia , Masculino , Terapia Passiva Contínua de Movimento/métodos , Fármacos Neuromusculares/uso terapêutico , Procedimentos Ortopédicos/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Resultado do Tratamento
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