Relapsing and residual clubfoot deformities after the application of the ponseti method: a contemporary review

The Ponseti method is a safe and effective treatment for congenital clubfoot, and radically decreases the need for extensive corrective surgery. But a group of patients will still present with under corrected residual equinovarus deformities despite the proper use of the Ponseti method. About 25% of operated clubfeet will develop recurrence or show a marked residual deformity [recurrent clubfoot]; however, in the recent literature, the failure rate of the Ponseti method, defined by the need for corrective surgery, ranges from 3% to 5%. Deformities encountered in patients with residual clubfeet comprise of various degrees of equinus, varus, adduction, supination, cavus, and toe deformity. Joint flexibility or stiffness, tarsal dysmorphism, articular incongruence, and progressive degrees of degeneration may be also present. We try to emphasize the current solutions for these deformities

[ comparison between the role of MRI and arthroscopy in the diagnosis of traumatic knee lesions]

The knee is one of the most frequently injured joints. Clinical tests in the diagnosis of meniscus and ligament injuries have limitations and it may not be possible to elicit objective signs repeatedly. MRI, has been shown to improve diagnostic accuracy in many knee disorders. Its principal attractiveness over arthroscopy is that, it is noninvasive. To determine the effectiveness of magnetic resonance imaging in the appropriate identification of traumatic intra articular knee lesions, we compared its findings with clinical examination and arthroscopy as a gold standard technique in a descriptive cross sectional study. Overall 100 patients with knee trauma were entered and completed the study. All patients had thorough clinical examination by experienced physicians. An MRI of the affected knee was requested in all patients. Arthroscopies were performed for all of them. Overall 55 knees were reported to have ACL tear arthroscopically, Meniscal injuries were found in 75 cases. We found correlation between posterior drawer test, MRI report of PCL tear and arthroscopic PCL tear. The sensitivity of MRI for detecting Meniscal tear: represented high, for bucket handle tear of medial meniscus, and high specificity for lateral meniscal tear. It is concluded that arthroscopy still remains the gold standard technique. More powerful MRI scan equipments with better soft wares will be needed in order to have much better diagnosis