Chronologic Outcome of Surgical Tendoachilles Lengthening and Natural History of Gastroc-Soleus Contracture in Cerebral Palsy

Damron, Timothy A.; Greenwald, Thomas A.; Breed, Alan L.

doi:10.1097/00003086-199404000-00039

Cited by 40 publications

(35 citation statements)

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“…Damron et al [19] found no clear relationship between age and outcome. Seven studies reported that a younger age at index surgery was associated with an increased risk of recurrent equinus, but one study found that age was not related to recurrent equinus [36].…”

Section: Outcome Assessmentmentioning

confidence: 96%

“…Seven studies reported on the rates of recurrent equinus deformity following surgical lengthening in Zone 2 (the Baker and Vulpius procedures) [14,17,19,26,30,42,45] (Table 3). Eleven studies reported a Zone 1 procedure, comprising three Baumann and eight Strayers.…”

Section: Outcome Assessmentmentioning

confidence: 99%

“…Calcaneus deformity, calcaneus gait and crouch gait by topographical distribution Nine of the 35 studies reported explicit criteria for calcaneal gait, calcaneal deformity or crouch gait [2,17,19,20,22,27,38,39,44]. These definitions included the inability to passively plantarflex the foot to neutral, greater than 14°T of ankle dorsiflexion in stance or 10°of ankle dorsiflexion greater than the normal, as a definition of calcaneus deformity and the need for a floor reaction orthosis for crouch gait.…”

Section: Outcome Assessmentmentioning

confidence: 99%

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Surgical correction of equinus deformity in children with cerebral palsy: A systematic review

Shore

White

Graham

2010

Journal of Children's Orthopaedics

101

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Purpose Equinus is the most common deformity in cerebral palsy. However, despite the large volume of published studies, there are poor levels of evidence to support surgical intervention. This study was undertaken to examine the current evidence base for the surgical management of equinus deformity in cerebral palsy. Methods A systematic review of the literature using “equinus deformity”, “cerebral palsy” and “orthopaedic surgery” generated 49 articles. After applying inclusion and exclusion criteria, 35 articles remained. The Oxford Centre for Evidence-Based Medicine (CEBM) levels of evidence and the Methodological Index for Non-Randomized Studies (MINORS) were used to grade the articles. Results Studies ranged in sample size from 9 to 156 subjects, with an average of 38 subjects. The mean age of subjects at index surgery ranged from 5 to 19 years. Nineteen studies used instrumented gait analysis, with an average follow-up of 2.8 years. Seven studies reported that a younger age at index surgery was associated with an increased risk of recurrent equinus. The average rate of calcaneus in hemiplegic children was 1% and it was 15% in those with spastic diplegia. Most studies were level 4 quality of evidence, leading to, at best, only grade C recommendation. Conclusions Cerebral palsy subtype (hemiplegia versus diplegia) and age at index surgery were the two most important variables for determining the outcome of surgery for equinus deformity in cerebral palsy. Despite the great emphasis on differences in surgical procedures, there was less evidence to support the type of operation in relation to outcome.

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Section: Outcome Assessmentmentioning

confidence: 96%

Section: Outcome Assessmentmentioning

confidence: 99%

Section: Outcome Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

Surgical correction of equinus deformity in children with cerebral palsy: A systematic review

Shore

White

Graham

2010

Journal of Children's Orthopaedics

101

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“…7,8 Many surgical procedures have been described for the treatment of this deformity including partial neurectomy of the gastrocnemius, 9,10 lengthening of the origin of the gastrocnemius, 11,12 recession of the proximal gastrocnemius aponeurosis, 13 combined lengthening of the gastrocnemius/ soleus fascia, [14][15][16] and lengthening 4,[17][18][19] and translocation 20 of tendo Achillis. Previous studies have reported recurrent equinus in approximately 10% to 30% of patients with hemiplegia 5,21 and calcaneus in 3% to 30% of patients with diplegia. 20,[22][23][24][25][26][27] In an independent walker with an equinus gait, calf lengthening is commonly undertaken to improve gait.…”

mentioning

confidence: 91%

Isolated calf lengthening in cerebral palsy

Borton

Walker

Pirpiris

et al. 2001

The Journal of Bone and Joint Surgery. British volume

107

130

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We reviewed 195 procedures in 134 children; 45 had hemiplegia, 65 diplegia and 24 quadriplegia. We established the incidence of calcaneus and recurrent equinus and identified 'at-risk' groups for each. At follow-up, 42% had satisfactory calf length, 22% had recurrent equinus and 36% calcaneus. The incidence of calcaneus in girls at follow-up was significantly higher (p = 0.002) while boys had an increased rate of recurrent equinus (p = 0.012).Children with diplegia who had surgery when aged eight years or younger had a 44% risk of calcaneus, while those over eight years had a 19% risk (p = 0.046). Percutaneous lengthening of tendo Achillis in diplegia was the least predictable, only 38% having a satisfactory outcome compared with 50% in the other procedures.The incidence of recurrent equinus in hemiplegic patients was 38%. Only 4% developed calcaneus. The type of surgery did not influence the outcome in patients with hemiplegia or quadriplegia.Severity of involvement, female gender, age at operation of less than eight years and percutaneous lengthening of tendo Achillis were 'risk factors' for calcaneus. Hemiplegia, male gender, and an aponeurosis muscle lengthening increased the risk of recurrent equinus.

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“…The definition of the joint contracture is a loss of passive and active ranges of motion of a joint [2,3]. Though the contracture usually disturbs activities of daily living in various aspects, its management is still now controversial and challenging [4,5]. Because there is no definite therapy and prevention for the contracture, short period of immobilization is the only way to avoid joint contracture.…”

Section: Introductionmentioning

confidence: 99%

Expression of type I collagen in the capsule of a contracture knee in a rat model

Hagiwara¹,

Chimoto²,

Andõ³

et al. 2007

Upsala Journal of Medical Sciences

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Contracture is a very common complication in daily examination and a fibrotic change of a capsule is suggested to be a one of the main causes. Type I collagen is a major component of a synovial capsule and also has been implicated in tissue elasticity of other organs. We immobilized the knee joints of 66 rats in 150 degrees of flexion using a plastic plate and metal screws. Sham operated knee joints had holes drilled and screws inserted but none of them were plated. The expression patterns of type I collagen were characterized using in situ hybridization and immunohistochemistry. The in situ hybridization demonstrated that the mRNA of type I collagen decreased rapidly after immobilization. However, the immunoreactivity of the capsule was not changed in the immobilized and the control groups at any time points. Other processes might be considered to evaluate the contracture capsule.

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Chronologic Outcome of Surgical Tendoachilles Lengthening and Natural History of Gastroc-Soleus Contracture in Cerebral Palsy

Cited by 40 publications

References 0 publications

Surgical correction of equinus deformity in children with cerebral palsy: A systematic review

Surgical correction of equinus deformity in children with cerebral palsy: A systematic review

Isolated calf lengthening in cerebral palsy

Expression of type I collagen in the capsule of a contracture knee in a rat model

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