Aims

The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach.

The Ponseti and French taping methods have reduced the incidence of major surgery in congenital idiopathic clubfoot but incur a significant burden of care, including heel-cord tenotomy. We developed a non-operative regime to reduce treatment intensity without affecting outcome. We treated 402 primary idiopathic clubfeet in patients aged < three months who presented between September 1991 and August 2008. Their Harrold and Walker grades were 6.0% mild, 25.6% moderate and 68.4% severe. All underwent a dynamic outpatient taping regime over five weeks based on Ponseti manipulation, modified Jones strapping and home exercises. Feet with residual equinus (six feet, 1.5%) or relapse within six months (83 feet, 20.9%) underwent one to three additional tapings. Correction was maintained with below-knee splints, exercises and shoes. The clinical outcome at three years of age (385 feet, 95.8% follow-up) showed that taping alone corrected 357 feet (92.7%, ‘good’). Late relapses or failure of taping required limited posterior release in 20 feet (5.2%, ‘fair’) or posteromedial release in eight feet (2.1%, ‘poor’). The long-term (> 10 years) outcomes in 44 feet (23.8% follow-up) were assessed by the Laaveg–Ponseti method as excellent (23 feet, 52.3%), good (17 feet, 38.6%), fair (three feet, 6.8%) or poor (one foot, 2.3%). These compare favourably with published long-term results of the Ponseti or French methods. This dynamic taping regime is a simple non-operative method that delivers improved medium-term and promising long-term results.

Cite this article: Bone Joint J 2013;95-B:271–8.

Background: Prophylactic taping is commonly used to prevent ankle injuries during sports. However unnatural constraint of the ankle joint may increase the risk of injury to proximal joints such as the knee. Any association between the use of ankle tape and knee joint loading has not previously been investigated. Purpose: To determine changes in ankle and knee kinetics and kinematics associated with use of ankle taping during athletic activities. Thereby, both the prophylactic benefits and the potential of taping to be an isolated mechanism for a ligamentous injury of the knee will be examined. Methods: A kinematic and inverse dynamics model was used to determine ankle and knee joint motion and loading in 22 healthy male participants undertaking running and sidestepping tasks. Both tasks were randomized to planned and unplanned conditions, and undertaken with and without the use of ankle tape. Results: Taping reduced the range of motion at the ankle in all three planes (p< 0.05), as well as peak inversion (p=0.017) and average eversion moments (p=0.013). At the knee, internal rotation moments (p=0.049), internal rotation impulse (0.034), varus moment (p=0.015) and varus impulse (p=0.050) were reduced with the use of ankle tape. There was a trend toward increased valgus impulse for sidestepping trials undertaken with ankle tape (p=0.056). Conclusion: By limiting motion at the ankle, taping increased the mechanical stability of this joint. Ankle taping also provided protective benefits to the knee via reduced internal rotation moments and varus impulses, although the effects were task-specific. Medial collateral and anterior cruciate ligament injuries may, however, occur through increased valgus impulse during sidestepping undertaken with ankle tape