Evidence map›Paper›PMID 25100771›Full record

ArticleThe Journal of bone and joint surgery. American volume2014

Soft-Tissue Abnormalities Associated with Treatment-Resistant and Treatment-Responsive Clubfoot: Findings of MRI Analysis.

Daniel K Moon, Christina A Gurnett, Hyuliya Aferol, Marilyn J Siegel, Paul K Commean, Matthew B Dobbs

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of bone and joint surgery. American volume, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  12. Rare andJournal of medical genetics · 2020
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  16. What is new in idiopathic clubfoot?Current reviews in musculoskeletal medicine · 2016
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Daniel K MoonDepartments of Orthopaedic Surgery (D.K.M., C.A.G., H.A., and M.B.D.), Pediatrics (C.A.G.), Neurology (C.A.G.), and Radiology (M.J.S. and P.K.C.), Washington University School of Medicine, 1 Children's Place, Suite 4S-60, St. Louis, MO 62110. E-mail address for M.B. Dobbs: dobbsm@wudosis.wustl.edu.
Christina A GurnettDepartments of Orthopaedic Surgery (D.K.M., C.A.G., H.A., and M.B.D.), Pediatrics (C.A.G.), Neurology (C.A.G.), and Radiology (M.J.S. and P.K.C.), Washington University School of Medicine, 1 Children's Place, Suite 4S-60, St. Louis, MO 62110. E-mail address for M.B. Dobbs: dobbsm@wudosis.wustl.edu.
Hyuliya AferolDepartments of Orthopaedic Surgery (D.K.M., C.A.G., H.A., and M.B.D.), Pediatrics (C.A.G.), Neurology (C.A.G.), and Radiology (M.J.S. and P.K.C.), Washington University School of Medicine, 1 Children's Place, Suite 4S-60, St. Louis, MO 62110. E-mail address for M.B. Dobbs: dobbsm@wudosis.wustl.edu.
Marilyn J SiegelDepartments of Orthopaedic Surgery (D.K.M., C.A.G., H.A., and M.B.D.), Pediatrics (C.A.G.), Neurology (C.A.G.), and Radiology (M.J.S. and P.K.C.), Washington University School of Medicine, 1 Children's Place, Suite 4S-60, St. Louis, MO 62110. E-mail address for M.B. Dobbs: dobbsm@wudosis.wustl.edu.
Paul K CommeanDepartments of Orthopaedic Surgery (D.K.M., C.A.G., H.A., and M.B.D.), Pediatrics (C.A.G.), Neurology (C.A.G.), and Radiology (M.J.S. and P.K.C.), Washington University School of Medicine, 1 Children's Place, Suite 4S-60, St. Louis, MO 62110. E-mail address for M.B. Dobbs: dobbsm@wudosis.wustl.edu.
Matthew B DobbsDepartments of Orthopaedic Surgery (D.K.M., C.A.G., H.A., and M.B.D.), Pediatrics (C.A.G.), Neurology (C.A.G.), and Radiology (M.J.S. and P.K.C.), Washington University School of Medicine, 1 Children's Place, Suite 4S-60, St. Louis, MO 62110. E-mail address for M.B. Dobbs: dobbsm@wudosis.wustl.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundClubfoot treatment commonly fails and often results in impaired quality of life. An understanding of the soft-tissue abnormalities associated with both treatment-responsive and treatment-resistant clubfoot is important to improving the diagnosis of clubfoot, the prognosis for patients, and treatment.

methodsTwenty patients with clubfoot treated with the Ponseti method were recruited for magnetic resonance imaging (MRI) of their lower extremities. Among these were seven patients (six unilateral cases) with treatment-responsive clubfoot and thirteen patients (five unilateral cases) with treatment-resistant clubfoot. Demographic information and physical examination findings were recorded. A descriptive analysis of the soft-tissue abnormalities was performed for both patient cohorts. For the patients with unilateral clubfoot, we calculated the percentage difference in cross-sectional area between the affected limb and the unaffected limb in terms of muscle, subcutaneous fat, intracompartment fat, and total area. With use of the Wilcoxon signed-rank test, we compared inter-leg differences in cross-sectional areas and the intracompartment adiposity index (IAI) between treatment-responsive and treatment-resistant groups. The IAI characterizes the cross-sectional area of fat within a muscle compartment.

resultsExtensive soft-tissue abnormalities were more present in patients with treatment-resistant clubfoot than in patients with treatment-responsive clubfoot. Treatment-resistant clubfoot abnormalities included excess epimysial fat and intramuscular fat replacement as well as unique patterns of hypoplasia in specific muscle groups that were present within a subset of patients. Among the unilateral cases, treatment-resistant clubfoot was associated with a significantly greater difference in muscle area between the affected and unaffected limb (-47.8%) compared with treatment-responsive clubfoot (-26.6%) (p = 0.02), a significantly greater difference in intracompartment fat area between the affected and unaffected limb (402.6%) compared with treatment-responsive clubfoot (9%) (p = 0.01), and a corresponding higher inter-leg IAI ratio (8.7) compared with treatment-responsive clubfoot (1.5) (p = 0.01).

conclusionsMRI demonstrated a range of soft-tissue abnormalities in patients, including unique patterns of specific muscle-compartment aplasia/hypoplasia that were present in patients with treatment-resistant clubfoot and not present in patients with treatment-responsive clubfoot. Correlations between MRI, physical examination, and treatment responsiveness may aid in the development of a prognostic classification system for clubfoot. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Indexed as

Magnetic Resonance ImagingAdolescentAdultChildChild, PreschoolClubfootFemaleHumansMaleTreatment OutcomeYoung Adult

Identifiers

PMID25100771
PMCPMC4116564

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.