Calcaneal Lengthening for Planovalgus Deformity in Children with Cerebral Palsy

Chung

Clinical Orthopaedics &Amp; Related Research

et al. 2015

Background Calcaneal lengthening with allograft is frequently used for the treatment of patients with symptomatic planovalgus deformity; however, the behavior of allograft bone after calcaneal lengthening and the risk factors for graft failure are not well documented. Questions/purposes (1) What proportion of the patients treated with allograft bone had radiographic evidence of graft failure and what further procedures were performed? (2) What are the risk factors for radiographic graft failure after calcaneal lengthening? (3) What patient factors are associated with the magnitude of correction achieved after calcaneal lengthening? Methods Between May 2003 and January 2014, we performed 341 calcaneal lengthenings on 202 patients for planovalgus deformity, the etiology of which included idiopathic, cerebral palsy, and other neuromuscular disease. Of these, 176 patients (87%) had adequate followup for graft evaluation, defined as lateral radiographs taken before and at least 6 months after the index procedure (mean, 18 months; range, 6-100 months) and 117 patients (58%) had adequate followup for the assessment of the extent of correction, defined as weightbearing anteroposterior and lateral radiographs taken before and at least 1 year after the index procedure (mean, 24 months; range, 12-96 months). These patients' results were evaluated retrospectively. The Goldberg scoring system was chosen for demonstration of allograft behavior. A score lower than 6 at 6 months after surgery was defined as radiographic graft failure; the highest possible score was 7 points, and this represented graft incorporation with excellent reorganization of the graft and no loss of height. The patient age, sex, diagnosis, graft material, ambulatory status, and use of antiseizure medication were evaluated as possible risk factors, and we controlled for the interaction of potentially confounding variables using multivariate analysis. Additionally, six radiographic indices were analyzed for their effects on the extent of correction. Results The mean estimated Goldberg score was 6 (SD, 1.14) at 6 months after calcaneal lengthening with 11 feet (4%) classified as radiographic graft failure (Goldberg score \ 6). Of these, four feet (1%) underwent reoperation using an iliac autograft bone resulting from pain and loss of correction. Multivariate analysis showed that the tricortical iliac crest allograft was superior to the patellar allograft (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.1-9.8; p = 0.038) and the possibility of radiographic graft failure was found to increase along with age (OR, 1.2; 95% CI, 1.0-1.3; p = 0.006). Radiographically, the extent of correction was found to decrease with patient age, as

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Incidence and Risk Factors of Allograft Bone Failure After Calcaneal Lengthening

Chung

Clinical Orthopaedics &Amp; Related Research

et al. 2015

Journal of Children's Orthopaedics

“…Most of these feet also present when the deformity is not very severe because they become symptomatic earlier due to high force demands of the foot. Ambulatory children have had significantly better clinical and radiological outcomes (according to Mosca's criteria) than nonambulating children with calcaneal lengthening for correction of mild-to-moderate planovalgus deformity [10]. Calcaneal lengthening with concomitant peroneus brevislengthening is an effective procedure for correcting a planovalgus foot deformity; however, it should be noted that, for patients with a 23°AP talus-first metatarsal angle, 36°lateral talus-first metatarsal angle, and 72 % naviculocuboid overlap, additional procedures should also be considered [11].…”

Section: Varus Feetmentioning

confidence: 99%

Overview of foot deformity management in children with cerebral palsy

Sees

Miller

2013

Foot deformities in children with cerebral palsy are common. The natural history of the deformities of the feet is very variable and very unpredictable in young children less then 5 years old. Treatment for the young children should be primarily with orthotics and manual therapy. Equinus is the most common deformity, with orthotics augmented with botulinum toxin being the primary management in young children. When fixed deformity develops lengthening only the muscle which is contracted is preferred. Varus deformity of the feet is often associated with equinus, and can almost always be managed with orthotics until 8 or 10 years of age. Planovalgus is the most common deformity in children with bilateral lower extremity spasticity. The primary management is orthotics until the child no longer tolerates the orthotic; then surgical management needs to consider all the deformities and all should be corrected. This requires correcting the subtalor subluxation with calcaneal lengthening or fusion, medial midfoot correction with osteotomy or fusion.

“…Subsequently, numerous studies have reported the success of calcaneal lengthening for treatment of symptomatic flatfoot deformity in patients with CP [1, 2, 5, 9, 18-20, 22, 28, 29]. Some authors reported a 25% recurrence rate after calcaneal lengthening and other major limitations to this procedure in patients with CP [2,9]. Additional procedures such as a medial soft tissue procedure, medial bony procedure, or triple arthrodesis could be performed concomitantly with calcaneal lengthening, which depends on severity of the deformity.…”

Section: Introductionmentioning

confidence: 99%

Calcaneal Lengthening for Planovalgus Foot Deformity in Patients With Cerebral Palsy

Sung

Chung

Clinical Orthopaedics &Amp; Related Research

et al. 2013

Background Calcaneal lengthening has been used to correct planovalgus foot deformities in patients with cerebral palsy (CP). Questions/purposes This study was performed to investigate the amount of correction that can be achieved after calcaneal lengthening for the treatment of a planovalgus deformity in patients with CP and to provide cutoff values based on the preoperative radiographic measurements that suggest additional procedures to achieve satisfactory correction. Methods Seventy-five consecutive patients with CP who underwent calcaneal lengthening for planovalgus deformity were included. Radiographic indices were measured on preoperative and latest followup weightbearing foot radiographs. The cutoff values of the preoperative radiographic measurements between the corrected and undercorrected groups were analyzed. The cutoff values are the reference values that can judge the possibilities of sufficient correction of a planovalgus deformity by calcaneal lengthening. Results The mean age of the patients at the time of surgery was 11.0 ± 5.2 years and the minimum followup was 1.0 years (mean, 3.1 ± 2.2 years; range, 1.0-8.4 years). AP talus-first metatarsal angle, calcaneal pitch angle, talocalcaneal angle, lateral talus-first metatarsal angle, and naviculocuboid overlap showed major improvements after calcaneal lengthening. The cutoff values of preoperative measurements between the corrected and undercorrected groups were 23°AP talus-first metatarsal angle, 36°lateral talus-first metatarsal angle, and 72% naviculocuboid overlap. Conclusions Calcaneal lengthening with concomitant peroneus brevis lengthening is an effective procedure for correcting a planovalgus foot deformity in patients with CP. However, for patients with greater than 23°AP talusfirst metatarsal angle, 36°lateral talus-first metatarsal angle, and 72% naviculocuboid overlap, additional procedures for medial stabilization, such as tibialis posterior tendon reefing and talonavicular arthrodesis, should be considered as a result of the possibility of undercorrection with calcaneal lengthening alone.