Outcomes of Gastrocnemius-soleus Complex Lengthening for Isolated Equinus Contracture in Children With Cerebral Palsy

• Published in: Journal of pediatric orthopaedics Vol. 29; no. 7; pp. 771 - 778
• Main Authors: Tylkowski, Chester M, Horan, Mike, Oeffinger, Donna J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-10-2009; Lippincott Williams & Wilkins
• Subjects: Ankle Joint - physiopathology; Ankle Joint - surgery; Biological and medical sciences; Biomechanical Phenomena; Cerebral Palsy - physiopathology; Cerebral Palsy - surgery; Child; Clubfoot - physiopathology; Clubfoot - surgery; Diseases of the osteoarticular system; Female; Gait Disorders, Neurologic - physiopathology; Gait Disorders, Neurologic - surgery; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Muscle, Skeletal - surgery; Nervous system (semeiology, syndromes); Neurology; Range of Motion, Articular - physiology; Treatment Outcome; Human; Cerebral palsy; Nervous system diseases; Prognosis; Contracture; gait analysis; Cerebral disorder; Walking; children; outcomes; Orthopedics; Central nervous system disease; gastrocnemius-soleus complex lengthenings; Child
• ISSN: 0271-6798; 1539-2570
• DOI: 10.1097/BPO.0b013e3181b76a7c

BACKGROUNDThe goal of the gastrocnemius-soleus complex (GSC) lengthenings in children with cerebral palsy (CP) is to achieve a plantigrade foot and normalize kinematics during gait. The study purpose was to evaluate the results of GSC lengthening for isolated equinus contracture in individuals with CP. It was hypothesized that GSC lengthenings would normalize passive ankle range of motion, kinematic, kinetic, and temporal spatial parameters.
METHODSGait data from 15 able-bodied participants from the laboratory normal database and passive range of motion, kinematic, kinetic, and temporal spatial gait parameters, and oxygen cost were collected and analyzed for 27 individuals with CP (36 limbs) with isolated equinus contracture who received GSC lengthenings. Data were compared between preoperative and postoperative assessments.
RESULTSMean age at baseline was 11.4 years (±3.2 y). Mean time between surgery and postoperative gait analysis was 1.3 years (±0.3 y). Passive range of motion measurements were obtained. Kinematic and kinetic data for the hip, knee and ankle, and temporal spatial parameters were obtained from a representative gait trial preoperatively and postoperatively. Paired t tests (P<0.05) determined whether preoperative data differed from postoperative data or from able-bodied data. The passive range of motion at the ankle was improved and normalized postoperatively. Ankle kinematics normalized without compensatory changes occurring at the knee or hip kinematics. Ankle moments and powers become more normal but did not completely normalize. Kinematics and kinetics of the hip and knee were not adversely affected. No changes in the temporal spatial data or oxygen cost occurred postoperatively.
CONCLUSIONSThese data support the finding that with appropriate patient selection isolated GSC lengthening does not result in overcorrection.
LEVEL OF EVIDENCERetrospective comparative study; level 3.