Calcaneal lengthening for planovalgus foot deformity in children with spastic cerebral palsy

Noritake, Koji; Yoshihashi, Yuji; Miyata, Toru

doi:10.1097/01202412-200507000-00008

Cited by 38 publications

(39 citation statements)

References 10 publications

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“…In terms of the risk factors, the use of tricortical iliac allograft was found to be superior to patellar allograft, and the risk of radiographic graft failure was found to increase along with age. In terms of the extent of correction, our findings are comparable to those of the previous studied on the topic [1,5,23,25,33,37,38].…”

Section: Discussionsupporting

confidence: 88%

“…Furthermore, another risk factor for graft failure is age, and our study accordingly showed that the Goldberg score was decreased with increasing age, confirming that older patients may require more time for graft incorporation [11] and have a higher probability of graft failure. Our study measured the degree of correction after calcaneal lengthening by using six radiographic indices, which, in previous studies [1,5,23,25,33,37,38], have been reported to be improved after calcaneal lengthening, and we obtained comparable results (Table 5). In addition, we also investigated the risk factors affecting the extent of correction.…”

Section: Discussionsupporting

confidence: 60%

“…It is well known that a nonambulatory status is associated with poor outcomes after calcaneal lengthening in regard to the deformity correction [9,23,38]. However, this does not necessarily correlate with graft failure.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, younger patients maintained greater correction than did older patients with planovalgus deformity. Although previous studies have reported the severity of initial deformity [33] and ambulatory status [9,23,38] as factor affecting extent of correction, the effects of age on the extent of correction have not been well documented. We speculate that the more rigid the feet are, the lower the extent of correction achieved by calcaneal lengthening will be; and, because older patients may be more rigid, older age may hence result in a reduced extent of correction after the surgery.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Risk Factors of Allograft Bone Failure After Calcaneal Lengthening

Lee

Chung

Lee

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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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

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence and Risk Factors of Allograft Bone Failure After Calcaneal Lengthening

Lee

Chung

Lee

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Recently, other corrective surgical procedures have been more commonly used, such as the medial sliding osteotomy of the calcaneus [5,6] and the calcaneal lengthening osteotomy [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Grice arthrodesis in the treatment of valgus feet in children with myelomeningocele: A 12.8-year follow-up study

Høiness¹,

Kirkhus²

2009

Journal of Children's Orthopaedics

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Purpose Neurological deficit resulting in the lack of motor control in children with myelomeningocele often leads to a valgus position of the feet and ankles, usually in combination with planovalgus and pronation of the forefoot. The purpose of the study was to evaluate long-term patient satisfaction and clinical effects in ambulating children with lumbosacral myelomeningocele after having performed a Grice arthrodesis of a valgus unstable foot. The clinically most relevant radiographic measurements, such as the frontal and lateral talo-calcaneal angles, were used to evaluate the anatomical effects of the surgery, whereas the main research question was to reveal the patient satisfaction and usefulness of the procedure. Methods The modified Grice-Green extraarticular subtalar arthrodesis was performed by the same surgeon on one standing and 22 walking patients (12 female) with lumbosacral myelomeningocele and valgus instability during the period 1985-1999. Twelve patients had bilateral surgery, giving a total of 35 operated feet. The patients attended a thorough check-up at a mean of 12.8 years (standard deviation [SD] ± 3.2, range 7.7-20.2 years) after surgery. The mean age at surgery was 6.6 years (SD ± 1.8) and at follow-up 19.4 years (SD ± 3.8). Functional parameters, such as walking ability, pain and skin problems, and the need for braces and supportive orthopaedic shoes were noted at the follow-up interview. The parents were interviewed along with the patients in order to obtain all of the necessary information. Loaded radiographs in the lateral and frontal planes were taken of both feet and ankles pre-operatively and at follow-up, except for pre-operative radiographs in six patients that were not loaded and, thus, not included, except for the assessment of ankle valgus. Ankle valgus was assessed from lateral and frontal views of the ankle on a scale from grade 0 to grade 3 according to Malhotra. Frontal and lateral talo-calcaneal angles were measured for the assessment of subtalar varus or valgus. Lateral talo-first-metatarsal (Meary's) angles were measured to investigate the longitudinal arches of the feet. Results The mean lateral talo-calcaneal angle was reduced significantly (P \ 001) from 55.1°(SD ± 8.9) to 38.8°(SD ± 8.1). The mean frontal talo-calcaneal angle was reduced from 24.7°(SD ± 9.7) pre-operatively to 16.6°(SD ± 6.3) at follow-up (P \ 0.001). The mean lateral talo-first-metatarsal angle improved significantly from -16.1°(SD ± 24.7) pre-operatively to 0.9°(SD ± 15.1) at follow-up (P = 0.0015). The calcaneal pitch did not change significantly. In general, ankle valgus worsened during follow-up time, but not significantly (P = 0.113). The visual analogue scale (VAS) score of patient satisfaction improved significantly from 3.7 (SD ± 1.7) prior to surgery to 7.2 (SD ± 1.5) at follow-up (P \ 0.005). Nineteen patients (83%) were satisfied with the surgery and would thus recommend the procedure. Conclusions Based on the radiological findings and patient satisfaction, the patients participa...

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Atlas of Foot and Ankle Procedures in Cerebral Palsy

Miller¹

2018

Cerebral Palsy

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Calcaneal lengthening for planovalgus foot deformity in children with spastic cerebral palsy

Cited by 38 publications

References 10 publications

Incidence and Risk Factors of Allograft Bone Failure After Calcaneal Lengthening

Incidence and Risk Factors of Allograft Bone Failure After Calcaneal Lengthening

Grice arthrodesis in the treatment of valgus feet in children with myelomeningocele: A 12.8-year follow-up study

Atlas of Foot and Ankle Procedures in Cerebral Palsy

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