Meta-Analysis
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World J Orthop. Jul 18, 2013; 4(3): 144-153
Published online Jul 18, 2013. doi: 10.5312/wjo.v4.i3.144
Ponseti method compared with soft-tissue release for the management of clubfoot: A meta-analysis study
Marios G Lykissas, Alvin H Crawford, Emily A Eismann, Junichi Tamai
Marios G Lykissas, Alvin H Crawford, Emily A Eismann, Junichi Tamai, Division of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
Author contributions: All authors contributed equally to this paper.
Correspondence to: Marios G Lykissas, MD, PhD, Division of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 217, Cincinnati, OH 45229, United States. mariolyk@yahoo.com
Telephone: +1-513-6527207 Fax: +1-513-6527207
Received: January 9, 2013
Revised: March 27, 2013
Accepted: April 27, 2013
Published online: July 18, 2013
Abstract

AIM: To compare the functional outcomes of patients who underwent open surgery vs Ponseti method for the management of idiopathic clubfoot and to determine whether correlations exist between functional outcome and radiographic measurements.

METHODS: A meta-analysis of the literature was conducted for studies concerning primary treatment of patients with idiopathic clubfoot. We searched PubMed Medline, EMBASE, and the Cochrane Library databases from January 1950 to October 2011. Meta-analyses were performed on outcomes from 12 studies. Pooled means, SDs, and sample sizes were either identified in the results or calculated based on the results of each study.

RESULTS: Overall, 835 treated idiopathic clubfeet in 516 patients were reviewed. The average follow-up was 15.7 years. Patients managed with Ponseti method did have a higher rate of excellent or good outcome than patients treated with open surgery (0.76 and 0.62, respectively), but not quite to the point of statistical significance (Q = 3.73, P = 0.053). Age at surgery was not correlated with the functional outcome for the surgically treated patients (r = -0.32, P = 0.68). A larger anteroposterior talocalcaneal angle was correlated with a higher rate of excellent or good outcomes (r = 0.80, P = 0.006). There were no other significant correlations between the functional and radiographic outcomes.

CONCLUSION: The Ponseti method should be considered the initial treatment of idiopathic clubfeet, and open surgery should be reserved for clubfeet that cannot be completely corrected.

Keywords: Idiopathic clubfoot, Congenital talipes equinovarus, Ponseti method, Surgical release, Ponseti-Laaveg score

Core tip: This study analyzed a large cohort of patients with idiopathic clubfoot and presented differences in the functional and radiographic outcomes based on the management employed. Although no statistically significant difference was noted in the overall functional outcomes between patients managed with the Ponseti method or open surgery, patients treated with the Ponseti method had a higher rate of excellent or good outcomes. Serial manipulation and casting has been widely accepted as the initial treatment of idiopathic clubfeet, and soft-tissue release is reserved for clubfeet that cannot be completely corrected. A strict brace compliance remains the major challenge of the Ponseti method.