Clinical and radiological long-term outcomes after resection of tarsal coalitions in children and adolescents: a case series with a minimum of a six year-follow-up
摘要
Resection of tarsal coalitions aims to relieve pain and restore hindfoot mobility, especially in young, active patients over the long term. This study investigated (1) long-term differences in clinical outcomes between calcaneonavicular (CN) and talocalcaneal (TC) coalition resections; (2) the frequency and clinical relevance of re-ossification; and (3) radiological signs of osteoarthritis in adjacent hindfoot joints.
MethodsIn this case series, 29 feet from 24 patients with a minimum follow-up of 80 months after tarsal coalition resection were examined. Clinical assessments included range of motion, AOFAS hindfoot score, FAOS, FFI, VAS, and Tegner activity scale. Bilateral standing radiographs and computed tomography (CT) scans were evaluated for re-ossification and degenerative changes.
ResultsThere were no significant differences in pain, function, or range of motion between CN and TC resections. Re-ossification at the resection site was observed in 14 of 29 feet and was associated with poorer FAOS (p = 0.007) and reduced passive supination (p = 0.030). Degenerative changes (I°–III° osteoarthritis) in the calcaneocuboid joint were significantly more frequent after CN resection (15 of 22 feet, p = 0.001).
ConclusionTarsal coalition resection in paediatric patients can result in good long-term clinical outcomes. However, partial or complete re-ossification is a frequent CT finding and is associated with pain and reduced function. Degenerative changes in the calcaneocuboid (CC) joint are more commonly observed in CN coalitions than in TC coalitions. This study highlights the need for improved strategies to prevent re-ossification and the need for long-term monitoring for joint degeneration after tarsal coalition resection in children and adolescents.