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©2013 Baishideng Publishing Group Co.
World J Orthop. Jul 18, 2013; 4(3): 144-153
Published online Jul 18, 2013. doi: 10.5312/wjo.v4.i3.144
Published online Jul 18, 2013. doi: 10.5312/wjo.v4.i3.144
Table 1 Comparison of Laaveg-Ponseti score between patients treated with the Ponseti method and surgically managed patients
Studies | Level of evidence | Mean follow-up (yr) | Time period of procedure | Patients (n) | Feet (n) | Laaveg-Ponseti score mean (95%CI) | Excellent/good Laaveg-Ponseti rating rate (95%CI) |
All Treatments | 500 | 810 | 86.2 (84.2-88.2) | 0.73 (0.67-0.78) | |||
Ponseti method | 147 | 224 | 86.3 (84.2-88.3) | 0.76 (0.69-0.81) | |||
Ippolito et al[1] | III | 19 | 1979-1984 | 32 | 49 | 85.4 (83.9-86.9) | 0.78 (0.64-0.87) |
Laaveg et al[5] | III | 18.8 | 1950-1967 | 70 | 104 | 87.5 (85.3-89.7) | 0.74 (0.65-0.82) |
Cooper et al[6] | IV | 34 | 1950-1967 | 45 | 71 | - | 0.78 (0.63-0.88) |
Soft-tissue release | 353 | 586 | 82.0 (69.5-94.5) | 0.62 (0.48-0.74) | |||
Ippolito et al[1] | III | 25 | 1973-1977 | 32 | 47 | 74.7 (71.4-78.0) | 0.43 (0.29-0.57) |
Dobbs et al[3] | III | 31 | 1972-1979 | 45 | 73 | 65.3 (62.9-67.7) | 0.33 (0.23-0.44) |
Fridman et al[10] | IV | 6.4 | 1986-2003 | 50 | 71 | 86.9 (84.1-89.6) | 0.80 (0.69-0.88) |
Schuh e et al[11] | IV | 4.5 | 1986-2000 | 86 | 130 | 95.6 (94.0-97.2) | - |
Singh et al[12] | IV | 13.8 | 1980-1996 | 18 | 33 | - | 0.82 (0.65-0.92) |
Prasad et al[13] | IV | - | - | 30 | 50 | - | 0.58 (0.44-0.71) |
Munshi et al[14] | III | 3.5 | - | - | 50 | 87.3 (83.1-91.5) | 0.78 (0.65-0.87) |
Herbsthofer et al[15] | IV | 6.7 | 1984-1994 | 38 | 62 | - | 0.47 (0.35-0.59) |
Abulsaad et al[16] | IV | 3.9 | 2000-2004 | 54 | 70 | - | 0.69 (0.57-0.78) |
Difference between treatments | Q = 0.45, P = 0.50 | Q = 3.73, P = 0.053 |
Table 2 Comparison of anteroposterior talocalcaneal angle, lateral talocalcaneal angle, and talocalcaneal index between patients treated with the Ponseti method and surgically managed patients
Studies | Patients | Feet | Talocalcaneal | ||
AP mean (95%CI) | Lateral mean (95%CI) | Index mean (95%CI) | |||
All treatments | 430 | 655 | 16.2 (14.9-17.5) | 26.9 (23.9-29.9) | 46.0 (41.4-50.7) |
Ponseti method | 147 | 224 | 15.8 (14.5-17.2) | 29.9 (19.3-40.5) | 45.7 (33.4-58.0) |
Ippolito et al[1] | 32 | 49 | 16.1 (14.6-17.6) | 38.8 (37.1-40.4) | 54.9 (51.7-58.0) |
Laaveg et al[5] | 70 | 104 | 14.5 (12.8-16.2) | 20.9 (19.8-22.0) | 35.5 (33.5-37.5) |
Cooper et al[6] | 45 | 71 | 17.0 (15.1-18.9) | 30.0 (28.4-31.6) | 47.0 (43.5-50.5) |
Soft-tissue release | 283 | 431 | 18.9 (15.0-22.8) | 26.6 (23.5-29.8) | 46.1 (41.0-51.1) |
Ippolito et al[1] | 32 | 47 | 14.1 (12.2-16.0) | 33.2 (30.7-35.7) | 47.3 (42.9-51.7) |
Dobbs et al[3] | 45 | 73 | 12.8 (11.1-14.4) | 23.3 (21.8-24.8) | 36.1 (32.9-39.3) |
Fridman et al[10] | 50 | 71 | 20.8 (19.3-22.3) | 22.5 (20.9-24.0) | 43.3 (40.9-45.6) |
Singh et al[12] | 18 | 33 | 28.4 (27.0-29.8) | 30.9 (29.2-32.6) | 59.3 (56.2-62.4) |
Prasad et al[13] | 30 | 50 | 18.5 (16.2-20.8) | 27.4 (24.6-30.1) | 45.8 (43.3-48.4) |
Herbsthofer et al[15] | 38 | 62 | 16.1 (14.6-17.6) | 23.0 (21.3-24.7) | 39.1 (36.0-42.2) |
Abulsaad et al[16] | 54 | 70 | 16.4 (15.1-17.6) | 21.4 (19.9-23.0) | 42.2 (39.7-44.7) |
Docquier et al[17] | 16 | 25 | 24.3 (21.5-27.1) | 32.2 (29.6-34.8) | 56.5 (51.1-61.9) |
Difference between treatment | Q = 2.09, P = 0.15 | Q = 0.33, P = 0.57 | Q = 0.002, P = 0.96 |
Table 3 Comparison of talus-1st metatarsal, 1st-5th metatarsal, and calcaneus-5th metatarsal angles between patients treated with the Ponseti method and surgically managed patients
Studies | Patients | Feet | Talus-1st metatarsal | 1st-5th metatarsal | ||
APmean (95%CI) | Lateralmean (95%CI) | Lateralmean (95%CI) | APmean (95%CI) | |||
All treatments | 516 | 655 | 1.27 (-0.23-2.77) | 6.24 (5.00-7.48) | 15.6 (16.7-17.9) | -5.11 (-6.83 - -3.40) |
Ponseti method | 147 | 224 | 0.96 (-0.59-2.51) | 5.51 (4.20-6.82) | 15.4 (14.7-16.1) | -6.49 (-8.33 - -4.65) |
Ippolito et al[1] | 32 | 49 | 0.94 (-1.01-2.89) | 6.39 (4.40-8.38) | 15.5 (14.2-16.7) | -6.8 (-9.20 - -4.40) |
Laaveg et al[5] | 70 | 104 | - | - | 14.7 (13.5-15.9) | -4.9 (-6.92 - -2.88) |
Cooper et al[6] | 45 | 71 | 1 (-1.56-3.56) | 5 (3.60-6.40) | 16 (14.8-17.2) | -8 (-10.33 - -5.67) |
Soft-tissue release | 283 | 431 | 6.04 (-0.06-12.13) | 12.08 (8.38-15.79) | 25.2 (19.3-31.0) | 3.86 (-0.84 - 8.57) |
Ippolito et al[1] | 32 | 47 | 8.28 (5.97-10.59) | 9.4 (6.69-12.11) | 22.1 (20.3-23.9) | -0.62 (-3.04 - 1.80) |
Dobbs et al[3] | 45 | 73 | 15.95 (13.24-18.66) | 7.68 (4.06-11.30) | 18.1 (15.4-20.8) | 10.32 (8.55 - 12.09) |
Fridman et al[10] | 50 | 71 | 3.97 (1.27-6.67) | - | - | 1.32 (-0.70 - 3.34) |
Singh et al[12] | 18 | 33 | 11.9 (9.89-13.91) | 15.7 (13.14-18.26) | 28.2 (25.9-30.5) | - |
Prasad et al[13] | 30 | 50 | 6.92 (2.49-11.35) | 18.54 (11.90-25.18) | 46.2 (38.7-53.7) | 5.8 (2.22 - 9.38) |
Herbsthofer et al[15] | 38 | 62 | 10.29 (7.68-12.90) | - | - | 9.95 (7.90 - 12.00) |
Abulsaad et al[16] | 54 | 70 | -5.43 (-6.85-4.02) | - | - | - |
Docquier et al[17] | 16 | 25 | -3.5 (-6.52-0.48) | 10.9 (6.43-15.37) | 15.9 (12.7-19.1) | -3.9 (-7.04 - -0.76) |
Difference between treatment | Q = 2.50, P = 0.11 | Q = 10.74, P = 0.001 | Q = 10.48, P = 0.001 | Q = 16.12, P < 0.001 |
Table 4 Between and within-study heterogeneity in outcomes of clubfoot treatment
Overall | Ponseti method | Soft-Tissue release | ||||
Q | I2 | Q | I2 | Q | I2 | |
Laaveg-Ponseti score | 468.8a | 98.7 | 2.3 | 57.2 | 465.8a | 99.1 |
Excellent/Good Laaveg-Ponseti ratings | 72.5a | 86.2 | 0.35 | 0 | 55.6a | 87.4 |
TCA-AP | 346.8a | 97.1 | 4.1 | 50.9 | 312.5a | 97.8 |
TCA-LT | 496.3a | 98.0 | 320.8a | 99.4 | 158.1a | 95.6 |
TCI | 274.5a | 96.4 | 114.3a | 98.3 | 265.5a | 95.4 |
TMT-AP | 376.3a | 97.6 | 0.001 | 0 | 365.2a | 98.1 |
TMT-LT | 67.3a | 91.1 | 1.3 | 20.5 | 21.0a | 80.9 |
MTT-LT | 203.8a | 96.6 | 2.3 | 12.0 | 89.0a | 95.5 |
CMT-AP | 328.7a | 97.6 | 4.0 | 50.6 | 121.5a | 95.9 |
Table 5 Correlations between functional and radiographic outcomes after clubfoot treatment
Length of follow-upr (P value) | Laaveg-Ponseti excellent/good outcomesr (P value) | |
TCA-AP | -0.31 (0.39) | 0.80 (0.006) |
TCA-LT | 0.43 (0.22) | -0.26 (0.46) |
TCI | 0.13 (0.73) | 0.48 (0.16) |
TMT-AP | 0.27 (0.49) | -0.36 (0.34) |
TMT-LT | -0.66 (0.16) | -0.06 (0.91) |
CMT-AP | -0.26 (0.53) | -0.64 (0.091) |
MTT-LT | 0.11 (0.82) | -0.13 (0.79) |
- Citation: Lykissas MG, Crawford AH, Eismann EA, Tamai J. Ponseti method compared with soft-tissue release for the management of clubfoot: A meta-analysis study. World J Orthop 2013; 4(3): 144-153
- URL: https://www.wjgnet.com/2218-5836/full/v4/i3/144.htm
- DOI: https://dx.doi.org/10.5312/wjo.v4.i3.144