Kinematic and Kinetic Evaluation of the Ankle Joint Before and After Tendo Achilles Lengthening in Patients With Spastic Diplegia

Abstract

Fourteen patients, at a mean age of 9.1 years (range 4.1-16.6 years), who had spastic diplegic cerebral palsy were evaluated before and after tendo Achilles lengthening (TAL). Follow-up (by gait analysis) after TAL ranged from 8 to 30 months. A Vicon motion analysis system with six CCD cameras and two AMTI force plates provided three-dimensional measurements of joint motion and moments. The TAL procedure resulted in normal passive dorsiflexion of the ankle joint with the knee at 0 degrees of extension and 90 degrees of flexion, reduced plantarflexion during swing phase, and reduced premature plantarflexor moment. However, 10 degrees greater than normal dorsiflexion of the ankle joint during mid-stance phase was indicative of a mild calcaneal gait pattern. The TAL procedure improved lower extremity function as documented by both kinematic and kinetic analysis in cerebral palsy.

Surgical correction of equinus deformity in children with cerebral palsy: A systematic review

“…The older literature reported above-knee casts for at least 6 weeks with long periods of restricted weightbearing [16]. The more recent literature reports the use of below-knee casts and earlier weight-bearing [2,14,15,20,21,24,28,29,37]. The utilisation of ankle-foot orthoses (AFO) after cast removal, the type of AFO and the utilisation of night splints varied greatly and were poorly described in several studies.…”

“…Kay et al [2] reported no significant difference in the rates of calcaneus gait in children with spastic diplegia who had either a gastrocnemius recession or an Achilles tendon lengthening (Table 4). Thirteen studies reported the rates of calcaneus gait in hemiplegic children [14,15,17,19,20,26,29,30,34,[38][39][40]45]. Again, Kay et al [2] found no significant difference in calcaneus gait in hemiplegic children who had either a gastrocnemius recession or a lengthening of the Achilles tendon.…”

“…The overall recurrence rates varied from 0 to 43%, but this increased up to 62% when specific sub-groups were considered (hemiplegia compared to diplegia). The majority of studies reporting three-dimensional gait analyses had short-term follow-up and reported much lower rates for recurrent equinus deformity than the clinical studies, which all included a mean follow-up of at least 5 years [27,29,31,37,41,44].…”

“…Calcaneal deformity was seen postoperatively in all three surgical zones, with slightly differing rates of occurrence. Twelve studies reported the rate of calcaneus for operative procedures in Zone 3 [2,17,19,20,25,27,29,33,34,39,40,42]. One study reported on the development of a spastic flat foot and knee flexion deformity as a postoperative complication [43] (Table 2).…”

“…The rate of recurrent equinus deformity for procedures involving lengthening of the Achilles tendon was given in 13 studies [2,16,17,19,25,27,29,33,34,36,40,42,43] ( Table 2). Seven studies reported on the rates of recurrent equinus deformity following surgical lengthening in Zone 2 (the Baker and Vulpius procedures) [14,17,19,26,30,42,45] (Table 3).…”