A cohort study of tibialis anterior tendon shortening in combination with calf muscle lengthening in spastic equinus in cerebral palsy |
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| Affiliation: | 1. Department of Orthopaedics, Royal Hospital for Sick Children Edinburgh, 9 Sciennes Place, Edinburgh EH9 1LF, United Kingdom;2. University of Edinburgh, College of Medicine and Veterinary Medicine, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, United Kingdom;3. The Anderson Gait Laboratory, SMART Centre, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh EH9 2, United Kingdom;1. Department of Kinesiology and Sport Management, Texas Tech University, P.O. Box 43011, Lubbock, TX, 79409-3011, USA;2. Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA;3. Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA;4. Department of Human Development and Family Studies, Texas Tech University, Lubbock, TX, USA;1. Pediatric Orthopedics and Foot Surgery, Center for Orthopedic and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany;2. Orthopedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstrasse 18, 83229 Aschau i. Chiemgau, Germany;1. Department of Physiotherapy, Monash University, Australia;2. Clinical Research Centre for Movement Disorders & Gait, Monash Health, Australia;3. Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway,;4. University of Gothenburg, Institution of Neuroscience and Physiology, Rehabilitation Medicine, Gothenburg, Sweden;5. Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Australia;1. Gillette Children’s Specialty Healthcare, 200 University Avenue East, Saint Paul, MN 55101, United States;2. Hospital da Baleia Rua Juramento, 1464 – Saudade Brazil Belo Horizonte, 30285-000, Brazil;3. University of Minnesota Orthopaedic Surgery 350 V C R C 401 E River Rd Minneapolis, MN, 55455, United States;1. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea;2. Department of Mathematics, College of Natural Sciences, Ajou University, Gyeonggi, South Korea |
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| Abstract: | ![]()
The aim of this study was to evaluate the outcome of combined tibialis anterior tendon shortening (TATS) and calf muscle-tendon lengthening (CMTL) in spastic equinus.Prospectively collected data was analysed in 26 patients with hemiplegic (n = 13) and diplegic (n = 13) cerebral palsy (CP) (GMFCS level I or II, 14 males, 12 females, age range 10–35 years; mean 16.8 years). All patients had pre-operative 3D gait analysis and a further analysis at a mean of 17.1 months (±5.6 months) after surgery. None was lost to follow-up. Twenty-eight combined TATS and CMTL were undertaken and 19 patients had additional synchronous multilevel surgery. At follow-up 79% of patients had improved foot positioning at initial contact, whilst 68% reported improved fitting or reduced requirement of orthotic support. Statistically significant improvements were seen in the Movement Analysis Profile for ankle dorsi-/plantarflexion (4.15°, p = 0.032), maximum ankle dorsiflexion during swing phase (11.68°, p < 0.001), and Edinburgh Visual Gait Score (EVGS) (4.85, p = 0.014). Diplegic patients had a greater improvement in the EVGS than hemiplegics (6.27 -vs- 2.21, p = 0.024).The originators of combined TATS and CMTL showed that it improved foot positioning during gait. The present study has independently confirmed favourable outcomes in a similar patient population and added additional outcome measures, the EVGS, foot positioning at initial contact, and maximum ankle dorsiflexion during swing phase. Study limitations include short term follow-up in a heterogeneous population and that 19 patients had additional surgery. TATS combined with CMTL is a recommended option for spastic equinus in ambulatory patients with CP. |
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| Keywords: | Cerebral palsy Equinus Gait |
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