Split Anterior Tibial Tendon Transfer (SPLATT) in Revision Surgery for Clubfeet

Abstract

Purpose: Revision surgery in clubfeet is needed in approximately 25 % of the patients following the first surgical correction. Results of additional SPLATT in revision surgery, which is combined with surgical soft-tissue and bony procedures, are reported in this paper. Material and
Methods: Twenty-one revision surgeries in 17 children were performed with complete soft-tissue release and additional SPLATT, alone or combined with Heyman-Herndon (metatarsal capsulotomies) operations in 3 feet, Lichtblau procedure in 5 feet, Evans procedure in 2 feet, Dwyer procedure in 2 feet, and metatarsal base osteotomy in 1 foot, between 1988 and 1995. Average age of the children was 5.29 years (3 to 10), and the average time between the first and second interventions was 37.1 months (10 months to 7 years). The lateral half of the anterior tibial tendon was anchored to the 2nd cuneiform in 8 feet, to the 3rd cuneiform in 8 feet, and to the cuboid bone in 5 feet according to preoperative foot deformity. Average follow-up period was 46.2 months (12 to 71).
Results: Results were graded according to 'Functional rating system for clubfoot surgery' of Atar et al. Excellent results were obtained in 7 feet, good results in 10 feet, fair results in 3 feet, and poor result in 1 foot. The overall percentage of satisfactory results were 80.95 %.
Conclusion: Additional SPLATT in revision surgery for clubfoot has a dynamic effect of correcting deformity, and facilitating the postoperative rehabilitation program.