Muscle-Tendon Surgery in Diplegic Cerebral Palsy: Functional and Mechanical Changes

Abel, Mark F.; Damiano, Diane L.; Pannunzio, Michael E.; Bush, Jeffrey L

doi:10.1097/01241398-199905000-00016

Cited by 81 publications

(84 citation statements)

References 35 publications

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“…Kay et al [2] reported no significant difference in the rates of calcaneus gait in children with spastic diplegia who had either a gastrocnemius recession or an Achilles tendon lengthening (Table 4). Thirteen studies reported the rates of calcaneus gait in hemiplegic children [14,15,17,19,20,26,29,30,34,[38][39][40]45]. Again, Kay et al [2] found no significant difference in calcaneus gait in hemiplegic children who had either a gastrocnemius recession or a lengthening of the Achilles tendon.…”

Section: Outcome Assessmentmentioning

confidence: 99%

“…The older literature reported above-knee casts for at least 6 weeks with long periods of restricted weightbearing [16]. The more recent literature reports the use of below-knee casts and earlier weight-bearing [2,14,15,20,21,24,28,29,37]. The utilisation of ankle-foot orthoses (AFO) after cast removal, the type of AFO and the utilisation of night splints varied greatly and were poorly described in several studies.…”

Section: Postoperative Carementioning

confidence: 99%

“…One study reported on the development of a spastic flat foot and knee flexion deformity as a postoperative complication [43] (Table 2). Nine studies reported the rate of calcaneus following surgical procedures in Zone 2 [14,15,17,19,26,30,39,42,45] (Table 3). Five studies reported the rate of calcaneus following Zone 1 surgical procedures [2,18,27,37,40] ( Table 4).…”

Section: Outcome Assessmentmentioning

confidence: 99%

“…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%

“…The outcome measures reported included clinical examination and rating scales [2,11,, gait rating scales [2, 14, 16-18, 20-22, 24, 25, 27, 29, 30, 32, 33, 36, 39, 42], goniometry [2,14,17,21,25,36,44], three-dimensional gait analysis [2, 11, 14, 15, 17, 21-24, 28, 29, 31, 32, 35, 37-39, 41, 44, 46], the modified Ashworth scale (spasticity) [2,11,36,37], radiographs [17,32,45], electromyography [11,15,23,24,35,38], the Gross Motor Function Measure (GMFM) [14,21] and the need for floor reaction AFOs to manage crouch gait [20,26]. Such measures were used to derive an outcome scale, which rated the overall result from good to poor.…”

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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