Pediatric orthopedists from the Pediatric Orthopaedic Society of North America (POSNA) have diverse methods for performing Tibialis Anterior Tendon Transfer (TATT) to treat recurrent clubfoot with dynamic supination. A recent survey sheds light on the prevailing practices and reveals significant variability despite consensus on some key aspects.
Survey Methodology and Participation
The survey, conducted using the Research Electronic Data Capture (REDCap) software, included 15 initial questions with the potential for 22 total questions based on conditional follow-ups. The Evidence Based Practice Committee of POSNA approved the survey, which was distributed to the society’s 1,370 members. Only responses from those who treated clubfoot and performed TATT were analyzed, totaling 228 respondents.
Key Findings
Among the respondents, there was a strong consensus (75% agreement) on several treatment aspects. Notably, 94% endorsed the Ponseti method for clubfoot treatment, and 77% preferred transferring the tibialis anterior tendon to the lateral cuneiform. Additionally, 79% opted to transfer the whole tibialis anterior tendon, and 94% used ankle-foot orthoses postoperatively for those employing braces.
Despite these agreements, the survey revealed significant variations in other practices. This disparity underscores the absence of a standardized approach for performing TATT in recurrent clubfoot cases. The differences in techniques and their execution highlight the need for further research to establish optimized, standardized protocols.
From a market access perspective, the variability in TATT techniques may impact the availability and consistency of care. Standardizing methods could potentially improve market access by ensuring uniformity in treatment outcomes, thus enhancing patient confidence and reducing procedural disparities.
Concrete Inferences:
- 94% of orthopedists use the Ponseti method, indicating strong adherence to this technique.
- 77% perform the tendon transfer to the lateral cuneiform, showing a preference for this anatomical site.
- 79% transfer the whole tendon, suggesting a majority preference for this approach.
- 94% utilize ankle-foot orthoses postoperatively, emphasizing the importance of post-surgical support.
The survey’s findings highlight the need for more comprehensive studies to develop standardized guidelines for TATT. Such guidelines could facilitate better training, more consistent results, and improved patient outcomes, ultimately enhancing market access by ensuring high-quality care is universally available.
Original Article:
Bull Hosp Jt Dis (2013). 2024 Sep;82(3):172-177.
ABSTRACT
PURPOSE: The aim of this project was to survey members of the Pediatric Orthopaedic Society of North America (POSNA) regarding the use of tibialis anterior tendon transfer (TATT) in the management of recurrent clubfoot with dynamic supination and no deformity. We aimed to assess which techniques for TATT are most utilized by pediatric orthopedists. As there has been no general consensus in the literature regarding best methods, we hypothesized that treatment methods would vary widely among POSNA members.
METHODS: The online survey, designed using Research Electronic Data Capture (REDCap) survey software, consisted of 15 initial questions, some of which had conditional follow-up questions that appeared if the respondent selected a specific answer choice, with a potential total of 22 questions. The survey was approved by the Evidence Based Practice Committee of POSNA and distributed to their 1,370 members.
RESULTS: Only the responses of POSNA members who treated clubfoot and performed TATT were included in the analysis. The 228 survey respondents reached a consensus (75% agreement) on a small number of topics: use of the Ponseti treatment method for clubfoot (94%), transfer of the tibialis anterior tendon to the lateral cuneiform (77%), transfer of only the whole tibialis anterior tendon (79%), and the use of an ankle foot orthoses (94%) among those who reported using postoperative braces. However, the remaining survey questions revealed a marked amount of variability in the performance of TATT.
CONCLUSIONS: Many of the questions garnered varied responses, which suggests differing opinions of POSNA members regarding how and when TATT should be performed for recurrent clubfoot with dynamic supination and no deformity. This is one of the first compilations of information about the treatment variations for TATT and may lead to further studies examining ways to standardize and optimize its use.
PMID:39150870
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