Is shortening of Tibialis Anterior in addition to calf muscle lengthening required to improve the active dorsal extension of the ankle joint in patients with Cerebral Palsy?

Dussa, Chakravarthy U.; Böhm, Harald; Döderlein, Leonhard; Fujak, Albert

doi:10.1016/j.gaitpost.2020.10.019

Cited by 5 publications

(27 citation statements)

References 23 publications

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“…The remaining 223 articles were screened via full text independently by the authors (N.S., E.R.). Thirty-three articles appropriately met the inclusion criteria and were included in this review [ 11 , 12 , 19 , 20 , 21 , 22 , 23 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Further details regarding conditions for exclusion and the final number of included studies are represented by the PRISMA diagram in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…All 33 studies involved GSL for the management of equinus deformity in children or adolescents with CP [ 11 , 12 , 19 , 20 , 21 , 22 , 23 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Four studies also included data from adults [ 28 , 29 , 30 , 43 ]. These were deemed appropriate for this review as a majority of the cohorts included participants under 18 years of age.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-nine studies [ 11 , 12 , 19 , 20 , 21 , 22 , 23 , 25 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ] focused on GSL, either used as an isolated procedure or as part of MLS ( Table S1 , Supplementary Materials ). Four studies [ 28 , 29 , 30 , 31 ] investigated outcomes of TATS, used in combination with GSL ( Table S2 , Supplementary Materials ). All were cohort studies, reporting original data [ 11 , 12 , 19 , 20 , 21 , 22 , 23 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ,…”

Section: Resultsmentioning

confidence: 99%

“…This procedure, performed in combination with GSL, may improve the function of the tibialis anterior muscle and hence improve ankle dorsiflexion during the swing phase of gait [ 28 ]. This has the potential to reduce the frequency of foot drop and obviate the need for long-term AFO use [ 29 , 30 ]. Retrospective cohort studies of the effectiveness of TATS have been published [ 28 , 29 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

“…This has the potential to reduce the frequency of foot drop and obviate the need for long-term AFO use [ 29 , 30 ]. Retrospective cohort studies of the effectiveness of TATS have been published [ 28 , 29 , 31 ]. However, there is currently no clear understanding of which children will experience post-operative foot drop and therefore who may benefit from TATS [ 28 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

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Ankle Dorsiflexor Function after Gastrocsoleus Lengthening in Children with Cerebral Palsy: A Literature Review

Sclavos

Passmore

et al. 2022

Medicina

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Background and Objectives: Ambulant children with cerebral palsy can demonstrate persistent “foot drop” after successful gastrocsoleus lengthening (GSL) surgery for equinus deformity. This may be due to inadequate strength and/or selective motor control of the ankle dorsiflexor muscles. A procedure has been developed to reduce foot drop—Tibialis Anterior Tendon Shortening (TATS), to be performed in conjunction with GSL. However, it is currently unclear how ankle dorsiflexor function changes after surgery and which children could benefit from TATS. This review summarises changes in ankle dorsiflexor function after GSL for equinus, as reported in the literature. Methods: A search was performed of the Medline, Embase and PubMed databases from 1980 to 5 March 2021. Keywords included “cerebral palsy”, “equinus deformity”, “orthopedic procedures” and “gait analysis”. The search identified 1974 studies. Thirty-three cohort studies met the inclusion criteria for this review. Results: Twenty-two studies reported improvement in swing phase ankle dorsiflexion kinematics, after GSL. There was also evidence that clinical measures of ankle dorsiflexor strength improved after surgery. Four studies reported changes in selective motor control, with mixed results across the studies. Conclusions: There is good evidence that swing phase ankle dorsiflexion improves after GSL surgery. Although, there is limited evidence that this correlates with reduced foot drop or diminished need for an ankle-foot orthosis. Future research should be prospective, randomised, include a large sample size, and should focus on identifying the optimal candidates for TATS.

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