[Comparison of long-term results between muscle-strength balancing procedure and Mckay procedure in treating congenital clubfoot]

Lianyong Li, Lijun Zhang, Enbo Wang
Chinese Journal of Reparative and Reconstructive Surgery 2007, 21 (10): 1108-12

OBJECTIVE: To compare the long-term results between the Mckay procedure and the muscle-strength balancing procedure in treatment of congenital clubfoot (CCF).

METHODS: Thirty-seven children with 54 clubfeet were treated by the muscle-strength balancing procedure (31 feet) or the Mckay procedure (23 feet). There were 27 males (38 feet) and 10 females (16 feet). The average age at the time of surgery was 1.2 years (range, 5 months to 3. 5 years). The deformity occurred on the left side in 7 patients, on the right side in 13, and on both sides in 17. During the muscle-strength balancing procedure, the anterior tibial tendon was transplanted to the middle or the lateral cuneiform, and the Achilles tendon was lengthened. During the Mckay procedure, the complete releasing of the soft tissues and the lengthening of the tendons were performed routinely; in addition, the abductor hallucis was also excised. The clinical outcomes were evaluated with the Diméglio classification method. According to the Diméglio scoring system, 3 clubfeet were at Grade I (score, 6-10); 26 clubfeet at Grade III (score, 11-15); 25 clubfeet at Grade IV (score, 16-20). Based on the Diméglio grading system, all the patients were divided into two groups before operation. Group A consisted of 29 feet at Grade II or III (score, 12.55 +/- 1.84); Group B consisted of 25 feet at Grade IV (score, 17.20 +/- 1.08). The score in the group undergoing the muscle-strength balancing procedure was 14.16 +/- 2.83, and the score in the group undergoing the Mckay procedure was 15.43 +/- 2.63.

RESULTS: All the patients were followed up for an average of 8. 2 years (range, 5.0-10.5 years). According to the Diméglio grading system, 32 patients were at Grade I and 22 patients at Grade II, and none of the patients at Grade III or IV. Two patients undergoing the Mckay procedure developed the postoperative incision infection, but the incision wound healed after the dressing changes. The Diméglio score was 4.07 +/- 1.25 in Group A and 6.52 +/- 1.74 in Group B after operation, with a significant difference when compared with before operation (P < 0.05). In Group A the two procedures had no significant difference in effectiveness (P > 0.05); however, in Group B they had a significant difference (P < 0.05). Judging by the correction degrees for the deformity on the different planes, the two procedures had no significant difference for correcting the equinus of hind foot (P > 0.05); however, in the correction degrees for the cross-foot and supination or adduction of the anterior foot, the Mckay procedure was significantly finer than the muscle-strength balancing procedure. It has a good biocompatibility. The mechanical test has showed that the Mckay procedure had the best result in the correction of the forefoot adduction.

CONCLUSION: For treatment of congenital clubfoot at Grades I - III, the muscle-strength balancing procedure can achieve an excellent correction result; for treatment of congenital clubfoot at Grade IV, the Mckay procedure should be performed. No matter which procedure, the abductor hallucis excision is recommended to prevent poor correction for the anterior foot adduction.

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