Title : Is it better to start Ponseti method for the treatment of congenital idiopathic clubfoot in the first 4 weeks of life? A systematic review and meta analysis
Abstract:
Introduction: The Ponseti method has been the main treatment for idiopathic clubfoot since the early 2000s, Controversies persist regarding the optimal age to start treatment.This systematic review and meta-analysis investigate the optimal age for initiating management and its effects on the number of casts, tenotomy needs, and relapse rates.
Methods: Conducted in accordance with PRISMA guidelines and registered in PROSPERO, this systematic review utilized databases, Google Scholar, MEDLINE, and EMBASE. Inclusion criteria involved studies determining age of initiation (more or less than 4 weeks) and reporting the number of casts,relapse rates, and tenotomy needs.Two co-authors independently evaluated the literature, resolving disagreements with a third reviewer. The risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS).
Result: A thorough search identified 2825 studies, with 2273 examined after removing duplicates, 6 included articles after 14 full-text evaluations. 467 individuals, comprising 689 feet, were enrolled in the study; 137 of them were under 4 weeks old, and 280 were over 4 weeks old. Each study had a low bias based on MINORS. Although younger patients needed considerably more casts (MD: 0.72, 95% CI [0.33,1.10], P = 0.0002), the meta-analysis found no significant difference in mean casts between age groups (MD: 0.06, 95% CI [-1.08, 1.21], P = 0.91). The rate of recurrence following tenotomy did not significantly correlate with any other factor.
Conclusion: Initiating Ponseti treatment in newborns under 4 weeks of age requires more casts, which indicate no need to start earlier to improve overall outcomes.
