TENDON TRANSFERS FOR HEREDITARY MOTOR AND SENSORY NEUROPATHY (CHARCOT-MARIE-TOOTH DISEASE)

Abstract

Introduction The role of tendon transfer in progressive hereditary motor sensory neuropathy (CMT) is controversial. This paper examines a large single surgeon cohort and reviews the surgical outcome of tendon transfers against a large group of CMT patients represented by the Australian CMT Health Survey 2001.

Methods A retrospective review was carried out in 29 patients (57 feet) with CMT, managed surgically by a single author (GW). Functional outcomes were measured using standard tools such as SF-36, AOFAS ankle hindfoot clinical rating scale, and a clinical review including a specially designed questionairre. Quality of life and functional outcome has been compared with the Australian CMT Health Survey 2001 in 324 patients. Twenty-nine patients were managed with tendon transfers, typically by flexor to extensor transfer of toes, combined with peroneus longus release and transfer, and tibialis posterior transfer.

Results The Levitt classification rated 80% of patients as having good-excellent outcomes. Ninety-two percent of patients reported an improvement overall with surgery, specifically 52% reported improvement in pain, 85% felt their gait had benefited, and 74% reported an improvement in the appearance of their foot deformity, as a direct result of their surgery. All patients reviewed would recommend similar surgery to others, and 92% of those surveyed wished they had their surgery much earlier (months to years). The AOFAS clinical rating system for ankle-hindfoot showed an average improvement of 36 points out of 100. In general, patients treated by this method were improved when considered against a larger cohort both in quality of life measures and functional outcome. This combination was not always successful, and a small number of disappointed patients were identified.

Conclusions Tendon transfers in the younger patient has a role in the treatment of flexible deformities in CMT, and improving quality of life. This paper shows that patients benefit at an earlier stage of their disease by tendon transfers. Indications for tendon transfers have been refined by this study and lessons learned recognised.