Clubfoot treatment with Ponseti method-parental distress during plaster casting.

BACKGROUND: Clubfoot is one of the most prevalent musculoskeletal congenital defects. Gold standard treatment of idiopathic clubfoot is the conservative Ponseti method, including the reduction of deformity with weekly serial plaster casting and percutaneous Achilles tenotomy. It is well known that parents of children with severe and chronic illnesses are mentally stressed, but in recent studies regarding clubfoot treatment, parents were only asked about their satisfaction with the treatment. Largely unknown is parental distress before and during plaster casting in clubfoot. Therefore, we want to determinate first, how pronounced the parents' worries are before treatment and if they decrease during the therapy. Second, we hypothesized that parents faced with an extreme deformity (high Pirani score), reveal more distress, than parents whose children have a less pronounced deformity (low Pirani score). Therefore, we wanted to investigate whether the Pirani score correlates with the parents' mental resilience in relation to the therapy of the child as a global distress parameter. METHODS: To answer this question, we developed a questionnaire with the following emphases: Physical capacity, mental resilience, motion score, parents score, and child score with point scores 1 (not affected) to 6 (high affected). Subsequently, we interviewed 20 parents whose children were treated with clubfeet and determined the Pirani score of the infants at the beginning (T0) and at the end (TE) of the treatment with plaster casting. RESULTS: High values were obtained in child score (Mean (M) = 3.11), motion score (M = 2.63), and mental resilience (M = 2.25). During treatment, mental resilience improved (p = 0.015) significantly. Spearman correlation coefficient between Pirani score (T0) and mental resilience (T0) is 0.21, so the initial hypothesis had to be rejected. CONCLUSION: The issues of the children are in the focus of parental worries concerning clubfoot treatment, especially the assumed future motion and the assumed ability to play with other children. Particular emphasis should be placed on educating parents about the excellent long-term results in the function of the treated feet especially as this topic shows the greatest parental distress.

Patients older than 55 years prefer biceps tenodesis over tenotomy to the same degree as young patients.

BACKGROUND: 55 years of age used to be the cutoff point when deciding between biceps tenotomy and tenodesis for treating biceps tendon pathologies. METHODS: Patients aged ≥18 years who had tendonitis in the long head of the biceps and were admitted for arthroscopic surgery were included. A questionnaire with a series of questions assessing patients' current symptoms, their concerns about their outcomes, and personal demographic information was introduced to the participants on the day before the surgery. The patients' preference toward tenotomy and tenodesis was assessed, and χ2 tests and logistic regressions were used to test the association with the categorical and ordinal variables, respectively. RESULTS: A total of 135 patients enrolled in the study, with 83 males and 52 females, the mean age of which was 56 years (range, 18-75 years). Of all patients, 86 (63.7%) preferred biceps tenodesis as opposed to tenotomy; meanwhile, there was no difference in preference toward tenodesis in each age- and gender-subgroup (range, 55.1% to 71.4%). The different subgroups had specific factors that were predictive of choosing either a tenotomy or tenodesis. In most subgroups, concerns about postoperative arm appearance and the so-called "Popeye" deformity due to tenotomy were factors predictive of choosing biceps tenodesis, whereas concern about longer rehabilitation due to tenodesis was the factor predictive of choosing biceps tenotomy. CONCLUSIONS: Biceps tenodesis is a more preferable choice for patients with biceps tendinopathies in all age and gender subgroups. Patients' concerns on postoperative arm appearance, "Popeye" deformity due to tenotomy, and longer rehabilitation due to tenodesis are the most important predictive factors.

Patient acceptance of long head of biceps brachii tenotomy.

HYPOTHESIS: Long head of biceps brachii tenotomy is well accepted by patients and the procedure has comparable outcomes in younger manually active and older sedentary populations. MATERIALS AND METHODS: A total of 117 individuals at least 12 months after tenotomy of the long head of biceps brachii attended for review. Typical of clinical practice, in only one patient was the tenotomy performed in isolation. Interviews, clinical examination, and strength testing were performed to determine the rates of (1) cosmetic deformity, (2) cramping pain in the biceps muscle, (3) weakness, and (4) patient satisfaction. RESULTS: There was no significant difference between the younger manually active and the older sedentary groups in measures of cramping, weakness, or deformity, and 95% of patients were satisfied or very satisfied with the outcome of their surgery. Three percent of patients were concerned with deformity but none requested correction. Objective testing found no statistical difference in elbow flexion or forearm supination strength between the operated-on and nonoperated-on sides. Nineteen percent of patients reported cramping sensations. DISCUSSION: This study demonstrated similar rates of adverse effects to previous tenotomy studies in cramping sensations, strength deficits, and cosmetic deformity. It demonstrated that results are similar in older sedentary and younger manually active patients and are comparable to the alternative, tenodesis. CONCLUSIONS: Biceps tenotomy is well accepted by most patients with good overall results. Some adverse effects occur but appear to be mild and of little concern to patients. The procedure is tolerated in manually active populations.