Comparative analysis of surgical treatment modalities for a popliteal pterygium: a meta-analysis

Martin Aman; Maiwand Sidiq; Anna Pennekamp; Leila Harhaus; Mirjam Thielen

doi:10.1007/s00402-024-05292-8

Comparative analysis of surgical treatment modalities for a popliteal pterygium: a meta-analysis

Arch Orthop Trauma Surg. 2024 May;144(5):2449-2459. doi: 10.1007/s00402-024-05292-8. Epub 2024 Apr 13.

Authors

Martin Aman¹, Maiwand Sidiq^{1

2}, Anna Pennekamp^{1

3}, Leila Harhaus^{1

4}, Mirjam Thielen⁵

Affiliations

¹ Department of Hand Surgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Heidelberg, Germany.
² Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, Böheimstraße 37, 72074, Tübingen, Germany.
³ Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
⁴ Section Upper Extremity, University Hospital Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
⁵ Department of Hand Surgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Klinik Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Heidelberg, Germany. mirjam.thielen@bgu-ludwigshafen.de.

PMID: 38613612
DOI: 10.1007/s00402-024-05292-8

Abstract

Introduction: Popliteal pterygium syndrome is a rare congenital disorder characterized by orofacial, cutaneous, musculoskeletal, and genital anomalies. The popliteal pterygium (PP) affects ambulation due to severe knee flexion contracture and equinovarus deformities. Surgical treatment aims to correct these deformities while preserving limb sensibility. However, due to its rarity, surgical guidelines are lacking.

Materials and methods: A meta-analysis according to PRISMA guidelines was conducted to summarize and compare surgical methods for PP. 183 paper were identified in PubMed and data from 32 articles were analyzed, including patient demographics, treatment modalities (Ilizarov fixator, femoral osteotomy, skin/soft tissue procedures, hamstring release, nerve surgery, and amputation), pre- and post-operative abilities to walk, knee joint parameters, complications, and recurrent contractions.

Results: Among 58 patients (87 limbs), Ilizarov fixator demonstrated improved knee and ankle mobility postoperatively, but showed a relatively high surgical session count and complication rates. Femoral osteotomy achieved successful knee posture correction with fewer sessions and no complications. Isolated skin/soft tissue procedures improved flexion contracture and mobility, though they required several procedures. Hamstring release achieved notable contracture reduction but also necessitated multiple interventions. Nerve surgery and amputation had limited data, warranting further investigation.

Conclusion: The management of PP demands a comprehensive approach, considering individual patient characteristics and treatment outcomes. While different surgical modalities offer distinct benefits, a classification or guideline to treat this deformity is still lacking. Further research is essential to validate findings, refine treatment approaches, and enhance the quality of life for individuals with PP.

Keywords: Knee flexion contracture; Meta-analysis; Popliteal pterygium; Popliteal webbing.

Publication types

Meta-Analysis
Comparative Study

MeSH terms

Humans
Lower Extremity Deformities, Congenital* / surgery
Osteotomy / methods