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Review
. 2022 Mar 2;9(3):339.
doi: 10.3390/children9030339.

Recurrence of Equinus Foot in Cerebral Palsy following Its Correction-A Meta-Analysis

Axel Horsch  1 , Matthias Claus Michael Klotz  2 , Hadrian Platzer  1 , Svenja Elisabeth Seide  3 , Maher Ghandour  1
Affiliations
Review

Recurrence of Equinus Foot in Cerebral Palsy following Its Correction-A Meta-Analysis

Axel Horsch et al. Children (Basel). .

Abstract

Background: Recurrence in cerebral palsy (CP) patients who have undergone operative or non-operative correction varies greatly from one study to another. Therefore, we conducted this meta-analysis to determine the pooled rate of equinus recurrence following its correction either surgically or non-surgically. Methods: Nine electronic databases were searched from inception to 6 May 2021, and the search was updated on 13 August 2021. We included all studies that reported the recurrence rate of equinus following its correction among CP patients. The primary outcome was recurrence, where data were reported as a pooled event (PE) rate and its corresponding 95% confidence interval (CI). We used the Cochrane’s risk of bias (RoB-II) tool and ROBINS-I tool to assess the quality of included randomized and non-randomized trials, respectively. We conducted subgroup analyses to identify the sources of heterogeneity. Results: The overall rate of recurrence was 0.15 (95% CI: 0.05−0.18; I2 = 88%; p < 0.01). Subgroup analyses indicated that the laterality of CP, study design, and intervention type were significant contributors to heterogeneity. The recurrence rate of equinus differed among interventions; it was highest in the multilevel surgery group (PE = 0.27; 95% CI: 0.19−0.38) and lowest in the Ilizarov procedure group (PE = 0.10; 95% CI: 0.04−0.24). Twelve studies had a low risk of bias, eight had a moderate risk, and nine had a serious risk of bias. Conclusion: The recurrence of equinus following its correction, either surgically or non-surgically, in CP patients is notably high. However, due to the poor quality of available evidence, our findings should be interpreted with caution. Future studies are still warranted to determine the actual risk of equinus recurrence in CP.

Keywords: equinus; meta-analysis; recurrence; surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the review process.
Figure 2
Figure 2
Forest plot of the overall recurrence of equinus.
Figure 3
Figure 3
Forest plot of subgroup analysis of equinus recurrence based on the laterality of CP.
Figure 4
Figure 4
Forest plot of subgroup analysis of equinus recurrence based on study design.
Figure 5
Figure 5
Forest plot of the subgroup analysis of equinus recurrence based on equinus definition.
Figure 6
Figure 6
Forest plot of the subgroup analysis of equinus recurrence based on intervention type.
See this image and copyright information in PMC

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