Anterior Tibial Tendon Transfer for Treatment of Recurrent Congenital Clubfoot Initially Treated According to Ponseti Method. Update and Systematic Review Of Literature

Background. Congenital clubfoot has a tendency to recur regardless the type of treatment; recurrences generally occur after a complete correction of the deformity. Anterior tibial tendon transfer (TATT) is commonly used for treatment of recurrent clubfeet in deformities initially treated according to Ponseti method, since extensive surgery has a high rate of poor results. The aim of our study was to analyze a series of papers, recently published, to evaluate the effectiveness of TATT for treatment of recurrent congenital clubfoot initially treated according to Ponseti method. Methods. A literature search on the topic was performed by searching the databases Medline (Pubmed) and Cochrane Library, to select only articles from the recent literature (January 2000 to January 2021). The articles were screened for the presence of the following inclusion criteria: patients affected by recurrent congenital clubfoot originally managed by Ponseti method and treated by anterior tibial tendon transfer. All the patients affected by non-idiopathic congenital clubfoot and by residual deformities or neglected deformities were excluded. Results. The initial search produced 123 studies from Medline database and 22 studies from Cochrane library database. After detailed evaluation based on inclusion and exclusion criteria, articles were screened and only 11 studies fulfilled the eligibility criteria of our study. All the selected articles were published from 2006 to 2020 and they included overall 331 patients (481 clubfeet). Conclusions. We believe that TATT is an effective surgical procedure to treat recurrent clubfeet initially treated by Ponseti method, independent of the type of surgical technique. A second recurrence is absolutely not common, however it is more frequent when TATT is performed in younger patients. TATT seems to be effective also in late relapse, although in some cases an associated surgical procedure is necessary.