Patellar tendon bearing orthosis - Application as adjunctive treatment in healing of lower-limb tissue loss

Objectives: to assess the efficacy of the patellar tendon bearing orthosis (PTBO) as adjunctive treatment of patients with significant lower-limb isch aemia and tissue loss complicated by neuropathy. Design, materials and methods: twelve consecutive patients (14 legs) with a variety of underlying conditions causing extensive lower limb tissue loss are described. Seven patients were diabetic. Six patients (seven legs) unde rwent vascular reconstruction procedures. Chief outcome measures: wound healing and amputation rate. Results: eight patients had ulcer healing within 5 months, one at 18 months (patient with alcoholic neuropathy who was poorly compliant with treatment ), one stopped using the PTBO at 3 months and was converted to protective f ootwear with healing, one died of a myocardial infarct I month after the PT BO was fitted (the ulcer was showing signs of healing), and one has just ha d surgery and been fitted with a PTBO. Conclusions: early results from this anecdotal series are encouraging and a prospective study to determine the application of the PTBO in patients wit h neuropathic and neuropathic/ischaemic tissue loss is planned.