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

Rutz, Erich and Baker, Richard and Tirosh, Oren and Romkes, Jacqueline and Haase, Celina and Brunner, Reinald (2011) Tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy. Gait and Posture, 33 (2). pp. 152-157. ISSN 0966-6362

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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 pre- to 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: ResPubID24301, cerebral palsy, spastic equinus, outcome, surgical correction
Subjects: Faculty/School/Research Centre/Department > Institute of Sport, Exercise and Active Living (ISEAL)
FOR Classification > 1103 Clinical Sciences
SEO Classification > 970111 Expanding Knowledge in the Medical and Health Sciences
Depositing User: VUIR
Date Deposited: 10 Sep 2012 00:57
Last Modified: 10 Sep 2012 00:57
URI: http://vuir.vu.edu.au/id/eprint/9392
DOI: 10.1016/j.gaitpost.2010.11.002
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Citations in Scopus: 5 - View on Scopus

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