Long Term Follow-up of Subcutaneous Achilles Tendon Lengthening in the Treatment of Spastic Equinus Foot in Patients with Cerebral Palsy

Krupiński, Marcin; Borowski, Andrzej; Synder, Marek

doi:10.5604/15093492.1157092

Cited by 9 publications

(8 citation statements)

References 8 publications

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“…More recently Krupinski et al presented a long-term followup, an average of 10 years, of subcutaneous Achilles tendon lengthening in the treatment of spastic equinus foot in patients with cerebral palsy, after Hooke's or White's isolated procedure. Although the recurrence of the deformity was reported in 43.42% of the patients, the Authors affirm that subcutaneous Achilles tendon lengthening is not associated with a risk of serious complications, while providing good long-term therapeutic outcomes as well as very good cosmetic and functional effects, minimizing the costs and time of patients' hospitalisation 89 . Farshad et al proposed, with an in vitro study, a new method for tendon -lengthening preserving a degree of tendon continuity.…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 80%

Musculotendinous equinus deformity correction: gastrocnemius or gastrosoleus release

Luna

Oliva

Bue

et al. 2019

Muscle Ligaments and Tendons J

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Introduction: Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet. There are several possible causes for the limited range of ankle motion, this deformity of the foot may result from either musculotendinous forms, osseous forms, or combined forms. Congenital deformities and neuromuscular diseases are the main causes of musculotendinous equinus, and they will be the subject of our review. Material and methods: Gastrocnemius release: An isolated gastrocnemius contracture (IGC) is often encountered in patients with foot and ankle pathology. Gastrocnemius contracture has been reported as an isolated entity as well as a problem associated with several forefoot, midfoot, or hindfoot pathologies. The gastrocnemius recession is one the oldest orthopaedic procedures described in the literature. This procedure has been performed for many years for contracture associated with pediatric neuromuscular disorders, and now it is an effective and predictable method for the treatment of spastic and non-spastic gastrocnemius equinus deformities. Over the past decade, there has been an increase in use of this procedure in the adult population. In general, surgical procedures for the correction of any form of ankle equinus are more effective, with better long-term results, in patients who are more physically active. Physical activity and state of health help to determine the surgical procedure and may indeed contraindicate surgical intervention. Once surgical correction has been elected, a surgical procedure aimed at correcting the specific condition may be chosen. Gastrosoleus release: Many surgical procedures have been described for the correction of a gastrosoleus equinus deformity. Most of these techniques have been oriented to elongation of the Achilles tendon, but there are other kinds of operations, like selective neurectomy and anterior advancement of the Achilles tendon, for the spastic forms of gastrosoleus equinus only. A tenotomy of the Achilles tendon may be considered for correction of either spastic or non-spastic gastrocnemius-soleus contractures, but it should generally not be used for the correction of a gastrocnemius equinus deformity. Discussion: Surgical procedures for the correction of equinus deformity by lengthening of the gastrocnemius or the gastrocnemius-soleus complex vary in terms of selectivity, stability, and range of correction. Procedures for the correction of musculotendinous equinus deformity have different anatomical, biomechanical and clinical characteristics. Level of evidence: Ia.

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Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 80%

Musculotendinous equinus deformity correction: gastrocnemius or gastrosoleus release

Luna

Oliva

Bue

et al. 2019

Muscle Ligaments and Tendons J

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“…All the joints could be involved, but usually, lower extremities are mostly affected. The advantages of minimally invasive percutaneous multilevel surgery for the treatment of CP are widely treated in the literature [19,20,28,[31][32][33][34][35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Multi-Level Fibrotomy for Pediatric Patients with Cerebral Palsy: A Cohort Study

et al. 2021

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Muscle retraction in Cerebral Palsy (CP) often requires surgical treatment. Multilevel procedures (using open or percutaneous techniques) are commonly performed in the ambulant patient with CP. The necessity to find new surgical techniques, reduce postoperative discomfort, and accelerate the healing process and rehabilitation is mandatory for these patients. A retrospective cohort study with 189 pediatric patients with CP was performed. The multilevel gradual fibrotomy of Ulzibat was modified using an ophthalmic knife. No significant complications were reported using our technique. Opioid drugs were not necessary, and casting time was reduced at the first 24 h. A significant Range of Motion recovery was assessed post-operatory and maintained at the last follow-up. Mean days of hospitalization were 2.2. The mean follow-up was 39 months (6–64 months). The modified multilevel fibrotomy reduces postoperative pain with easier patient management, resulting in a faster discharge from the hospital. However, the retrospective nature and the lack of a control group of the present study did not allow the authors to report significant results. Further studies with longer follow-up are in progress to obtain more certain data that confirm our preliminary results.

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“…The type of cerebral palsy was reported in thirteen studies, where one study reported a mixed CP type [41]. Twelve studies reported spastic CP [18,21,24,25,28,[30][31][32]35,[43][44][45], and one study reported athetoid CP [25]. The type of equinus was reported six studies, where one study reported static equinus [21] and five studies reported fixed equinus [18,26,[31][32][33].…”

Section: Study Characteristicsmentioning

confidence: 99%

Recurrence of Equinus Foot in Cerebral Palsy following Its Correction—A Meta-Analysis

Horsch

Klotz²,

Platzer

et al. 2022

Children

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Background: Recurrence in cerebral palsy (CP) patients who have undergone operative or non-operative correction varies greatly from one study to another. Therefore, we conducted this meta-analysis to determine the pooled rate of equinus recurrence following its correction either surgically or non-surgically. Methods: Nine electronic databases were searched from inception to 6 May 2021, and the search was updated on 13 August 2021. We included all studies that reported the recurrence rate of equinus following its correction among CP patients. The primary outcome was recurrence, where data were reported as a pooled event (PE) rate and its corresponding 95% confidence interval (CI). We used the Cochrane’s risk of bias (RoB-II) tool and ROBINS-I tool to assess the quality of included randomized and non-randomized trials, respectively. We conducted subgroup analyses to identify the sources of heterogeneity. Results: The overall rate of recurrence was 0.15 (95% CI: 0.05–0.18; I2 = 88%; p < 0.01). Subgroup analyses indicated that the laterality of CP, study design, and intervention type were significant contributors to heterogeneity. The recurrence rate of equinus differed among interventions; it was highest in the multilevel surgery group (PE = 0.27; 95% CI: 0.19–0.38) and lowest in the Ilizarov procedure group (PE = 0.10; 95% CI: 0.04–0.24). Twelve studies had a low risk of bias, eight had a moderate risk, and nine had a serious risk of bias. Conclusion: The recurrence of equinus following its correction, either surgically or non-surgically, in CP patients is notably high. However, due to the poor quality of available evidence, our findings should be interpreted with caution. Future studies are still warranted to determine the actual risk of equinus recurrence in CP.

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Long Term Follow-up of Subcutaneous Achilles Tendon Lengthening in the Treatment of Spastic Equinus Foot in Patients with Cerebral Palsy

Cited by 9 publications

References 8 publications

Musculotendinous equinus deformity correction: gastrocnemius or gastrosoleus release

Musculotendinous equinus deformity correction: gastrocnemius or gastrosoleus release

Multi-Level Fibrotomy for Pediatric Patients with Cerebral Palsy: A Cohort Study

Recurrence of Equinus Foot in Cerebral Palsy following Its Correction—A Meta-Analysis

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