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Talar morphologic changes after tendo -Achilles lengthening for long-standing equinus deformity in patients with residual poliomyelitis. Ki Hyuk Sung, MD Department of Orthopaedic Surgery Seoul National University Bundang Hospital. Introduction.
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Talar morphologic changes after tendo-Achilles lengthening for long-standing equinus deformity in patients with residual poliomyelitis Ki Hyuk Sung, MD Department of Orthopaedic Surgery Seoul National University Bundang Hospital
Introduction • Coronal angular deformity of the lower limb is a common finding in growing children • Permanent (irreversible) hemiepiphysiodesis • Temporary (reversible) hemiepiphysiodesis using staples, percutaneous screws, or a tension band plate (eight-plate)
Introduction • Measuring the rate of correction is necessary to predict the time to end point • The rate of angular correction has been calculated simply by averaging. • Other factors (age, surgical method, direction of deformity, etiology, physis) must be considered while estimating the rate of correction
Introduction • A linear mixed model (LMM) is useful in settings where multiple correlated measurements are made on the same statistical units • LMM consists of fixed effects and random effects • Estimation of the correction rate by using a mixed model application may confer more practical information to clinicians
Purpose • To investigate the talar morphologic changes after TAL for long-standing equinus deformity in patients with RP • To investigate whether the severity of preoperative equinus deformity affect occurrence of symptomatic anterior impingement.
Inclusion criteria • Consecutive patients with residual poliomyelitis, who underwent tendo-Achilles lengthening for equinus foot deformity since 2003 • Patients who had preoperative and postoperative weight bearing lateral foot-ankle radiographs • Patients with a minimum follow-up of 6 months
Exclusion criteria • Patients with inadequate foot-ankle radiographs for measurement • Patients with history of previous foot surgery • Patients who had concomitant anterior bony spur excision with TAL
Radiographic measurement • Lateral foot weight bearing radiograph • Talocalcaneal angle • Plantigrade angle • McDermott grade • Presence of anterior blocking spur
McDermott grade • grade 1, anterior tibial spur measuring less than 3mm • grade 2, anterior tibial spur measuring more than 3mm • grade 3, anterior tibial spur with secondary talar spur (kissing lesion) • grade 4, panarthritis
Statistical analysis • Comparison between preoperative and postoperative McDermott grade • Wilcoxon signed ranks test • Comparison of preoperative radiographic measurements between the patients with and without anterior ankle pain, and between the patients with and without anterior blocking spur • Independent t-test
Conclusion • Most of patients with RP showed the anterior ankle impingement after TAL for long-standing equinus deformity • The presence of symptomatic anterior ankle impingement was significantly associated with the severity of the equinus deformity.
Conclusion • Therefore, for the RP patients with severe long-standing equinus deformity, surgeons should consider the possibility of subsequent anterior procedure for anterior impingement after TAL.