Article

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.
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Langue : ANGLAIS