Safety and Efficacy of Botulinum Toxin A in Children Undergoing Lower Limb Lengthening and Deformity Correction

Abstract

Level I.

Is Botulinum Toxin Type A a Valuable Adjunct During Femoral Lengthening? A Randomized Trial

“…. and m = mean value; bars = SD; BtX-A = botulinum toxin type A was 3.6 IU/kg (range, 2.9-5.0 IU/kg) which is a smaller dose than those used in previous studies [9][10][11]. Therefore, a different dose, dilution, or schedule, or the use of repeated injections, may provide improvement.…”

“…More specifically, extension of the hip and flexion of the knee decrease because of tightness in the quadriceps [1,3,25]. To prevent this complication, BtX-A injections seem to be an appealing option; however, prior studies have disagreed regarding whether BtX-A is effective [9,10,17]. Previously, Lee et al [17] reported that BtX-A injection in the calf muscle during tibial lengthening was not effective.…”

“…It is possible that our selected dose was not effective. Hamdy et al [9][10][11] used a weight-based dose (10 IU/kg, up to maximal 400 IU) and concluded the injection of BtX-A during lengthening osteotomy was effective in pediatric patients. We used 200 IU as a standard dose on one muscle compartment for all patients because the injections were limited to the quadriceps muscles.…”

“…Local injection of BtX-A is commonly used to treat muscle spasticity and contracture in patients with cerebral palsy and brain injury [2,13,22,24]. Numerous authors have described the use of BtX-A during distraction osteogenesis in selected cases [9,10,17,20]. One animal study suggested that the use of BtX-A in distraction osteogenesis decreased the amount of ankle equinus contracture [20].…”

“…One animal study suggested that the use of BtX-A in distraction osteogenesis decreased the amount of ankle equinus contracture [20]. In some human studies, BtX-A injections appear to be effective for reducing pain and improving ROM during lower limb lengthening [9,10]. By contrast, Lee et al [17] showed that local injection of BtX-A did not decrease calf pain or improve ROM during tibial lengthening in adults.…”