Suture Button Technique for Tibialis Anterior Tendon Transfer for the Treatment of Residual Clubfoot. Issue 2 (14th May 2020)

• Record Type: Journal Article
• Authors: Rhee, Chanseok; Burgesson, Bernard; Orlik, Ben; Logan, Karl
• Is Part Of: Foot & ankle orthopaedics. Volume 5:Issue 2(2020)
• Publication Date: 2020-05-14
• Subjects: tibialis anterior tendon -- EndoButton -- suture button -- tendon transfer -- recurrent club foot; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Orthopedics -- Periodicals; 617.584
• DOI: 10.1177/2473011420923591
• Languages: English
• ISSNs: 2473-0114

Abstract

Background: The Ponseti method has revolutionized the treatment of idiopathic clubfoot, but recurrence remains problematic. Dynamic supination is a common cause of recurrence, and the standard treatment is tibialis anterior tendon transfer using an external button. Although safe and effective, the placement of the button on the sole creates a pressure point, which can lead to skin ulceration. In our institution, a suture button has been used for the tibialis anterior tendon transfer and we report our results here. Methods: Two senior authors' case logs were retrospectively reviewed to identify 23 patients (34 feet) for tibialis anterior tendon transfer using a suture button. Complications and additional operative procedures were assessed by reviewing operative notes, follow-up visit clinic notes, and radiographs. The mean age of the patients was 6 years 2 months (SD 40 months) and the average follow-up duration was 67.1 weeks (SD 72 weeks). Results: There were 5 complications (14.7%). Recurrence occurred bilaterally in 1 patient (5.9%) but did not require reoperation. Other complications included a cast-related pressure sore (2.9%) and an infection (2.9%) requiring irrigation with debridement along with hardware removal. Conclusions: Tibialis anterior tendon transfer using a suture button was a safe procedure with theoretical advantage of providing stronger fixation and reducing the risk of skin pressure necrosis compared to the standard external button technique. We believe a suture button could allow earlier rehabilitation and may afford stronger ankle eversion. Prospective studies are required to compare the differences in functional outcomes between the procedures. Level of Evidence: Level IV, case series, therapeutic study.