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Tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy

Rutz, E, Baker, RJ, Tirosh, O, Romkes, J, Haase, C and Brunner, R 2011, 'Tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy' , Gait & Posture, 33 (2) , pp. 152-157.

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    Abstract

    Equinus is the commonest deformity in cerebral palsy (CP). Many different surgical procedures have been described for the treatment of spastic equinus. In long standing equinus deformities the tibialis anterior muscle becomes elongated which is one reason for muscle weakness. Surgical tendon shortening of the tibialis anterior tendon was therefore introduced to rebalance muscle strength. All patients with CP who had a tibialis anterior tendon shortening (TATS) in combination with a tendo Achilles lengthening (TAL) were included in this study. A total of 29 patients had 30 surgical interventions (21 hemiplegic patients: 14 boys/7 girls, age 9–22 years; mean 15.2 years; 5 diplegics and 3 quadriplegics; 5 boys/3 girls, age 7–37.5 years; mean 14.8 years). Fifteen patients had additional surgery (soft tissue or bony procedures). The TATS was performed at the distal insertion with transosseous tendon fixation in the medial cuneiform bone at the original place. Movement Analysis Profile (MAP) for ankle dorsi-/plantarflexion, Gait Profile Score (GPS), Gait Deviation Index (GDI), and Gillette Gait Index (GGI) improved significantly for all patients compared preto postoperatively. In 93% of the patients active dorsiflexion of the ankle was possible postoperatively. We conclude that TATS in combination with TAL in spastic equinus in CP is a safe procedure and improves but not completely corrects foot positioning during gait. For the treatment of spastic equinus in CP we recommend shortening of the elongated antagonist (TATS) in combination with lengthening of the short agonist (TAL) for achieving optimal postoperative function.

    Item Type: Article
    Uncontrolled Keywords: Cerebral palsy, spastic equinus, outcome, surgical correction
    Themes: Health and Wellbeing
    Schools: Colleges and Schools > College of Health & Social Care
    Colleges and Schools > College of Health & Social Care > School of Health Sciences > Centre for Health Sciences Research
    Colleges and Schools > College of Health & Social Care > School of Health Sciences
    Journal or Publication Title: Gait & Posture
    Publisher: Elsevier
    Refereed: Yes
    ISSN: 0966-6362
    Depositing User: RH Shuttleworth
    Date Deposited: 03 Oct 2011 11:48
    Last Modified: 20 Sep 2013 11:15
    URI: http://usir.salford.ac.uk/id/eprint/17794

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