Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Future perspectives after the guidelines of degenerative cervical myelopathy: A narrative review","authors":"Narihito Nagoshi ,&nbsp;Yoshiharu Kawaguchi","doi":"10.1016/j.jcot.2025.103104","DOIUrl":"10.1016/j.jcot.2025.103104","url":null,"abstract":"<div><div>Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults, often resulting from cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL). As the aging population increases, the prevalence of DCM is expected to rise, making the optimization of treatment strategies crucial. While surgical decompression is widely accepted for moderate to severe cases, the management of mild DCM remains controversial. Some studies report significant neurological improvement with surgery, while others find no difference between surgical and conservative approaches. Current guidelines suggest conservative management may be considered for mild cases, with surgical intervention recommended if symptoms progress or do not respond to non-operative treatment.</div><div>Non-surgical approaches such as cervical traction therapy and orthotic treatment have been explored, though their long-term effectiveness remains unclear. Pharmacological treatments, including NSAIDs, muscle relaxants, and corticosteroids, are commonly prescribed for symptomatic relief, yet their effectiveness in treating myelopathy-specific symptoms has not been established. According to current guidelines, patients with a modified Japanese Orthopaedic Association (mJOA) score of 15 or higher are considered suitable candidates for conservative management. However, surgical intervention should be considered if there is evidence of symptom progression.</div><div>Surgical strategies for DCM vary based on the severity and location of spinal cord compression. The Japanese CSM and OPLL guidelines have extensively compared different surgical approaches. For CSM treatment, while anterior cervical discectomy and fusion (ACDF) and laminoplasty provide similar neurological recovery, ACDF offers better sagittal alignment but carries a higher risk of reoperation. Comparisons between ACDF and posterior decompression and fusion (PDF) indicate that both procedures yield comparable neurological outcomes, though ACDF has been associated with better patient-reported quality of life. In OPLL patients, anterior surgery may be preferable for those with severe kyphosis and extensive anterior compression, despite an increased risk of complications.</div><div>Future research should focus on refining diagnostic tools, optimizing surgical decision-making, and assessing the effectiveness of conservative management strategies. Standardizing intraoperative ultrasonography criteria, evaluating the role of postoperative cervical collar immobilization, and investigating rehabilitation protocols are key areas requiring further study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103104"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking effective decision-making and critical thinking in orthopaedics: Insights from a narrative review","authors":"A.S.P.V.S. Saketh ,&nbsp;Krishna Subramanyam ,&nbsp;Satvik N. Pai ,&nbsp;Karthika Padmavathy ,&nbsp;Karthick Rangasamy ,&nbsp;Purushothaman Muthukanagaraj","doi":"10.1016/j.jcot.2025.103098","DOIUrl":"10.1016/j.jcot.2025.103098","url":null,"abstract":"<div><h3>Background</h3><div>Clinical decision-making and critical thinking are vital in orthopaedic practice, directly impacting patient outcomes. Surgeons often face complex cases requiring both experience and systematic reasoning to ensure the best treatment approach. This review aims to explore the factors influencing decision-making in orthopaedics, focusing on the role of critical thinking in enhancing clinical choices. It examines decision-making frameworks, cognitive biases, and the importance of evidence-based practices. Additionally, the review discusses the increasing role of artificial intelligence (AI) and decision support systems in aiding clinical decisions.</div></div><div><h3>Methods</h3><div>This review analyzes peer-reviewed literature published from 2011 to 2024, covering case studies, surveys, qualitative research, and systematic reviews. Databases like PubMed, Scopus, Web of Science (WoS), and Google Scholar were used to source relevant articles. The focus was on decision-making frameworks, cognitive biases, and AI integration in orthopaedics, particularly studies on AI and data analytics in improving decision support systems.</div></div><div><h3>Results</h3><div>Structured decision-making frameworks and mentorship play a key role in enhancing critical thinking. Cognitive biases, such as confirmation and anchoring bias, are significant challenges. AI and evidence-based guidelines help improve clinical decisions by offering data-driven insights.</div></div><div><h3>Conclusions</h3><div>Optimizing clinical decision-making requires structured education, critical thinking development, and AI integration to improve patient outcomes and streamline decision-making.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103098"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The journal metrics of reality: Adjusting our gaze beyond the pandemic peak","authors":"Raju Vaishya ,&nbsp;Karthikeyan P. Iyengar","doi":"10.1016/j.jcot.2025.103097","DOIUrl":"10.1016/j.jcot.2025.103097","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103097"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the accuracy of Cuvis™ robot assisted total knee arthroplasty using offset type tensor system in ligament gap balancing","authors":"Woon-Hwa Jung,&nbsp;Minseok Seo,&nbsp;Vaibhav Sahu,&nbsp;Jignesh Tandel","doi":"10.1016/j.jcot.2025.103095","DOIUrl":"10.1016/j.jcot.2025.103095","url":null,"abstract":"<div><h3>Background</h3><div>Conventional total knee arthroplasty (TKA) is a widely accepted and cost effective procedure for treating symptomatic knee osteoarthritis. Despite its success, patient satisfaction rates range from 82 % to 89 %, primarily due to suboptimal functional outcomes, reduced implant longevity, and the need for revision surgeries stemming from component malalignment or soft tissue instability. Robot-assisted total knee arthroplasty (RA-TKA) offers a promising approach to address these challenges.</div></div><div><h3>Aim</h3><div>This study aims to evaluate the accuracy of robot-assisted total knee arthroplasty in achieving optimal ligament gap balancing, based on 159 cases performed in 2023.</div></div><div><h3>Method</h3><div>A total of 159 RA-TKA procedures using the Cuvis™ robot were conducted in 2023, with 9 valgus knees and 150 varus knees. Ligament gaps were measured twice by the robotic system: initially before bone cuts and subsequently after bone cuts. During surgery, an off-set type tensor was used to reassess ligament gaps. Cases exhibiting a discrepancy greater than 3 mm between extension and flexion gaps, as measured by both the tensor and robot, were included for further analysis. Discrepancies between surgeon-measured values and robot-predicted values were also evaluated.</div></div><div><h3>Result</h3><div>Of the 159 cases, 35 demonstrated a ligament gap discrepancy of more than 3 mm, as measured by the tensor. Among these, 24 cases (15 %) exhibited discrepancies between robotic measurements and tensor assessments. All 9 valgus knee cases showed discrepancies, while 15 varus knee cases also displayed discrepancies. The robot recorded 20 errors in ligament gap measurement, 2 errors in balancing, and 2 cases with both errors.</div></div><div><h3>Conclusion</h3><div>While robot-assisted TKA excels in bone cutting accuracy, errors in predicting ligament balancing and gaps remain in some cases. Therefore, caution is advised when adapting surgical strategies intra-operatively, relying solely on the Cuvis™ robotic system's measurements.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103095"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of reverse shoulder arthroplasty in obstetric brachial plexus palsy with suprascapular nerve injury and glenohumeral osteoarthritis","authors":"F. Granata ,&nbsp;S. D'Amato ,&nbsp;S. Cassaro ,&nbsp;C. Burgio ,&nbsp;F. Bosco","doi":"10.1016/j.jcot.2025.103096","DOIUrl":"10.1016/j.jcot.2025.103096","url":null,"abstract":"<div><h3>Background</h3><div>Untreated obstetric brachial plexus palsies (OBPP) present with various upper limb impairments, including muscle weakness, soft tissue contractures, and osteoarticular deformities. Reverse shoulder arthroplasty (RSA) medializes the center of rotation, optimizing deltoid function to compensate for deficits caused by OBPP. This study evaluates the effectiveness of RSA in patients with untreated OBPP involving the suprascapular nerve and end-stage glenohumeral osteoarthritis (OA), focusing on functional and quality-of-life improvements.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on patients with OBPP involving the suprascapular nerve and end-stage glenohumeral OA who underwent RSA. Included patients had significant deficits in the supraspinatus and infraspinatus muscles but preserved deltoid function. Pre- and postoperative assessments included Range of Motion (ROM), Visual Analog Scale (VAS), and Patient-Reported Outcome Measures (PROMs). Data on complications and revision surgeries were also collected.</div></div><div><h3>Results</h3><div>Seven patients (2 males, 5 females; mean age 38.9 ± 14.9 years) with a median follow-up of 3.1 ± 2.2 years were included. Postoperatively, significant improvements were observed in limb function and quality of life, as reflected in the Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS), and Quick Disabilities of the Arm, Shoulder, and Hand (QDASH). Pain levels decreased markedly, and ROM showed a moderate increase. No complications or revision surgeries were reported.</div></div><div><h3>Conclusions</h3><div>RSA is an effective and safe surgical option for patients with untreated OBPP involving the suprascapular nerve and end-stage glenohumeral OA, yielding significant functional and quality-of-life improvements at short- and mid-term follow-up. The absence of complications and revision surgeries further supports its reliability in this challenging patient population.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103096"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological impact of idiopathic clubfoot on Mothers: Insights from the ICCAP questionnaire","authors":"Anil Agarwal,&nbsp;K.S. Ankitha,&nbsp;Varun Garg,&nbsp;Kishmita Sachdeva,&nbsp;Ashish Upadhyay","doi":"10.1016/j.jcot.2025.103094","DOIUrl":"10.1016/j.jcot.2025.103094","url":null,"abstract":"<div><h3>Background</h3><div>Mothers who have a newborn with a physical defect often experience significant psychological distress. We surveyed mothers of children born with clubfoot to understand what parameters of parents’ quality of life and health are primarily affected and the changes thereof at correction of the deformity to guide the counseling process.</div></div><div><h3>Methods</h3><div>The affected mothers were administered the Impact of a Child with Congenital Anomalies on Parents (ICCAP) questionnaire. The responses were recorded prospectively at the enrolment of the child for treatment (foot with obvious clubfoot deformity) and one month post Achilles tenotomy (foot deformity fully corrected). Statistical analysis involved the use of mean responses for each ICCAP domain and intertreatment comparisons.</div></div><div><h3>Results</h3><div>Results were analyzed for 29 mothers. The affected mothers were largely satisfied (91.4 %) with their first contact with caregivers. The confidence grew significantly following the correction of deformity (scores improving from 4.39 ± 0.59 to 4.74 ± 0.3; p = 0.005). The social support remained strong throughout the Ponseti treatment. The partner relationships (pretreatment 4.57 ± 0.75; post treatment scores 4.48 ± 0.82; p = 0.69) and child acceptance (pretreatment 4.18 ± 0.62; post treatment 4.04 ± 0.59; p = 0.38) were also overall strong although somewhat affected by the casts and bracing protocol. The affected mothers recovered from a sad and depressed state following visualization of corrected deformity (pretreatment scores 3.09 ± 0.92 improving to 2.92 ± 1.04 post treatment; p = 0.52). They however continued to experience fear and anxiety regarding their child's immediate and long-term future (pretreatment scores of 3.42 ± 0.65 deteriorating to 3.56 ± 0.55 at the initiation of bracing; p = 0.34).</div></div><div><h3>Conclusions</h3><div>Mothers of children with clubfoot generally adapted well despite the child's physical deformity. The mother was subjected to early psychological stress which can extend even post correction of deformity. We suggest dedicated counseling of the affected clubfoot parents by the subject experts. The same may require periodic reinforcements during the treatment.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103094"},"PeriodicalIF":0.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of intra-and interobserver reliability analysis of orientation proximal femur physis parameters on radiographs","authors":"Varun Garg ,&nbsp;Anil Agarwal ,&nbsp;Kishmita Sachdeva ,&nbsp;K.S. Ankitha","doi":"10.1016/j.jcot.2025.103093","DOIUrl":"10.1016/j.jcot.2025.103093","url":null,"abstract":"<div><h3>Background</h3><div>The orientation of proximal femur physis is important as it can cause 3-dimensional deformity of the proximal femur. Recently, authors have described various parameters to describe the orientation of proximal femur physis. Therefore, we aim to compare the intra and interobserver reliability of these parameters in this study.</div></div><div><h3>Methods</h3><div>Radiographs of the bilateral hip with the pelvis of children between 1 and 10 years of age were retrieved from the hospital archives to measure the Physeal orientation angle (PO), Physeal tilt angle (PTA), Head shaft angle (HSA), and Alsberg angle (AA). Intra- and inter-observer reliability was tested using Pearson's correlation coefficient and Cronbach's alpha respectively by three independent observers at two separate times, two weeks apart.</div></div><div><h3>Results</h3><div>The total analysis included 179 radiographs, including 378 hips. PO, PTA, HSA, and AA had values ranging from 9.57⁰ -14.04⁰, 19.62°-25.04⁰, 58.75°-65.82⁰, and 24.47⁰ -31.79⁰, respectively, for the six data sets (three observers at two different times).The intra-observer reliability of PO, PTA, HSA, and AA ranged from 0.59- 0.72, 0.9–0.95, 0.91–0.95 and 0.86–0.95 respectively. PO, PTA, HSA, and AA had inter-observer reliability values between 0.79 -0.82, 0.88–0.92, 0.85–0.88, and 0.89–0.92, respectively.</div></div><div><h3>Conclusion</h3><div>The study found that PTA, AA, and HSA have shown good reliability, but they may not accurately represent the true orientation of the capital femoral physis with respect to the femoral neck. For routine follow-up, PO may be a suitable alternative. However, it is not as reliable as other parameters.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103093"},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do cast characteristics influence the post Achilles tenotomy treatment outcomes in Ponseti method?","authors":"Anil Agarwal,&nbsp;Kishmita Sachdeva,&nbsp;Varun Garg,&nbsp;Sunny Bhalla,&nbsp;Md Zafar Iqbal,&nbsp;Shekhar Gupta","doi":"10.1016/j.jcot.2025.103092","DOIUrl":"10.1016/j.jcot.2025.103092","url":null,"abstract":"<div><h3>Background</h3><div>The post tenotomy Ponseti cast is retained for three weeks. In a few children, the cast appears soiled especially at its proximal extent and sometimes, at the knee and foot sections as well. Some of these children manifest deterioration of the previously achieved clinical ankle dorsiflexion. This study aimed at investigating the characteristics of post tenotomy cast at follow up to study their influence on ankle dorsiflexion.</div></div><div><h3>Methods</h3><div>The study included 25 children with bilateral idiopathic clubfeet under the age 1 year treated with Ponseti method who also underwent percutaneous Achilles tenotomy for both feet (50 limbs). The cast characteristics evaluated were extent till groin, knee and ankle intactness along with firmness of plantar surface. Clinical ankle dorsiflexion was measured immediate post tenotomy and at follow up. Odds ratios were calculated to establish relationship between ankle dorsiflexion and cast characteristics.</div></div><div><h3>Results</h3><div>The mean child's age was 3.7 months. The immediate post tenotomy ankle dorsiflexion was 15.2° and at follow up was 14.2° (p = 0.0029). Sixteen casts (32 %) were found short near the groin edge at follow up. Out of these, 9 limbs (56 %) had lower ankle dorsiflexion measurements than those achieved immediate post tenotomy. Statistically, the likelihood of lost dorsiflexion was heightened 87 times with recessed groin margin compared to the intact casts (p = 0.003). Although the odds ratio of deterioration of ankle dorsiflexion with plantar surface break was even higher (odds ratio 160; p &lt; 0.0001), isolated plantar breaks without cast recession near the groin were not observed in any of the limbs.</div></div><div><h3>Conclusions</h3><div>The deteriorated cast characteristics at follow up may be responsible for loss of achieved ankle dorsiflexion immediately post tenotomy. The post tenotomy cast should be monitored better to keep its integrity and extent intact.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103092"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of revisions and fixations following periprosthetic fractures around the hip: a retrospective service evaluation","authors":"Styliani Zachari ,&nbsp;Amr H. Ahmed ,&nbsp;Alexander Mott ,&nbsp;Osama Tawfiq ,&nbsp;Syed S. Ahmed","doi":"10.1016/j.jcot.2025.103080","DOIUrl":"10.1016/j.jcot.2025.103080","url":null,"abstract":"<div><h3>Background</h3><div>Our study aims to report clinical outcomes of revision and ORIF for managing periprosthetic proximal femur fractures (PPFFs).</div></div><div><h3>Materials &amp; methods</h3><div>We conducted a two-year retrospective analysis at a level 2 trauma centre, focusing on surgically managed PPFFs from primary and revised total hip and hemiarthroplasties. <strong>Primary outcomes</strong> were the one-year reoperation rate and mortality rate following revision or ORIF. We also specifically analysed B2 fracture management. <strong>Secondary outcomes</strong> were complication rates, time to surgery, length of hospital stay, transfusions and critical care requirements.</div></div><div><h3>Results</h3><div>67 patients were included, 44 (66 %) of whom were female. Mean age at operation was 83 years. Among them, 27 (40 %) had revision and 40 (60 %) had ORIF. One year reoperation rate was 11.11 % for revision and 7.50 % for ORIF. One year mortality rate was 25.93 % for revision and 10 % for ORIF. The overall complication rate was 29.63 % for revision and 7.50 % for ORIF. Time to surgery (89 and 77 h) and length of hospital stay (18 and 17 days) were similar in both groups.B2 fractures, which constituted 48 (71.64 %) of the cases, had a higher proportion of revision surgeries (27) compared to ORIF (21). For B2 fractures, revision was associated with higher reoperation and mortality rates as well as a significantly greater complication rate compared to ORIF.</div></div><div><h3>Conclusion</h3><div>PPFFs present a substantial healthcare challenge. Improving clinical outcomes for PPFF patients is crucial. This study highlights that ORIF may yield better outcomes for B2 fractures, when anatomical reduction is feasible. (249 words)</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103080"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scar characteristics of percutaneous Achilles tenotomy in Ponseti Technique-A cross-sectional study","authors":"Varun Garg,&nbsp;Anil Agarwal,&nbsp;Kishmita Sachdeva,&nbsp;K.S. Ankitha","doi":"10.1016/j.jcot.2025.103090","DOIUrl":"10.1016/j.jcot.2025.103090","url":null,"abstract":"<div><h3>Background</h3><div>Clubfoot, a common birth defect, is treated with the Ponseti method. It involves an intensive phase of weekly casting and Achilles tenotomy as the last step in most of the cases. The tenotomy scar of percutaneous Achilles tenotomy may cause aesthetic concerns that could affect parental satisfaction or impede footwear use. This study aims to objectively evaluate the scar characteristics of percutaneous Achilles tenotomy during Ponseti treatment and parental perception of the same.</div></div><div><h3>Methods</h3><div>This study enrolled children with idiopathic clubfoot treated by Ponseti protocol with percutaneous Achilles tenotomy before 1 year of age and on bracing protocol between 2 and 4 years. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS 2.0) were used to assess scar quality. Complications such as hypertrophy, keloid formation, brace difficulty, footwear difficulty, and walking difficulties were noted.</div></div><div><h3>Results</h3><div>The study evaluated 82 scars in 50 children (35 males, 15 females). At the final follow-up, most of the scars were close to the normal skin. The mean value of the VSS and overall opinion of the observer and parents regarding the scar was 3.0 ± 1.0, 1.2 ± 0.5 and 2.2 ± 2.1 respectively. All children were able to walk using normal shoes and actively take part in outdoor activities and no complications such as hypertrophic scar or keloid formation were seen.</div></div><div><h3>Conclusion</h3><div>Percutaneous tenotomy causes minimal scarring and does not interfere with the general functioning of the child. The aesthetic characteristics of the scar are well-accepted by the parents. The use of percutaneous tenotomy should not be limited by the concern of a scar.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103090"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}