Long-term follow-up after tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy

Kläusler, Michèle; Speth, Bernhard M.; Brunner, Reinald; Tirosh, Oren; Camathias, Carlo; Rutz, Erich

doi:10.1016/j.gaitpost.2017.08.028

Cited by 24 publications

(37 citation statements)

References 20 publications

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“…This makes interpretation difficult as to whether TATS provides additional benefit to ankle kinematics, when added to GSL. However, using TATS, Klausler et al reported 0% overcorrection at a mean six-year follow-up period, with 25% of patients with USCP and 0% of patients with BSCP having recurrent equinus [30]. This is lower than other reported recurrent equinus rates of 38% in USCP and 16-35% in BSCP at similar follow-up periods [9,11,15,16].…”

Section: Discussionmentioning

confidence: 90%

“…Eleven studies [9,11,14,16,[20][21][22][23][24][25][26] specified the inclusion of fixed equinus, but not all used the widely used Silfverskiold test. Seventeen [9,11,12,14,16,[18][19][20]24,[27][28][29][30][31][32][33][34] studies specified the CP subtype as spastic CP. Thirty-three cohort studies and one Delphi consensus study of calf lengthening surgery for equinus were identified (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies [16,19,20,23,29,30,32,33] reported Gait Profile Scores (GPS). The GPS measures the difference between patients and people with no gait pathology across nine kinematic variables [8].…”

Section: Gait Scoresmentioning

confidence: 99%

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Three-Dimensional Gait Analysis in Children Undergoing Gastrocsoleus Lengthening for Equinus Secondary to Cerebral Palsy

Sclavos

Passmore

et al. 2021

Medicina

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Background and Objectives: Equinus is the most common deformity in children with cerebral palsy, and surgical lengthening of the gastrocsoleus muscle-tendon unit is the most commonly performed operation for children with cerebral palsy. Treatment outcomes of orthopaedic surgery can be measured objectively with three-dimensional gait analysis. This study examined the quality of evidence for gastrocsoleus lengthening surgery based on objective measures. Materials and Methods: A search was performed with Medline, Embase and PubMed from 1990 to 25 August 2020 using the keywords “cerebral palsy”, “equinus”, “surgery” and “gait analysis”. Only studies of gastrocsoleus lengthening surgery using three-dimensional gait analysis were included, yielding 34 studies. Results: Fourteen studies reported swing phase kinematics and all studies reported a significant improvement. Rates of recurrent equinus and calcaneus were reported in 21 studies and varied widely based on follow-up period and surgical technique. Conclusions: Poor study quality and marked variability in study samples and interventions made comparison difficult. Future studies should consider prospective design, controls or comparison groups and more detailed breakdowns of outcomes by cerebral palsy subtype, sagittal gait pattern, and equinus type in order to allow more rigorous treatment recommendations to be made.

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Section: Discussionmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

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Three-Dimensional Gait Analysis in Children Undergoing Gastrocsoleus Lengthening for Equinus Secondary to Cerebral Palsy

Sclavos

Passmore

et al. 2021

Medicina

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“…When patients reach puberty, we usually offer a surgical correction to replace the orthosis. While in patients with heel–toe gait patterns, a simple rebalancing of muscle-tendon lengths at the foot is sufficient (we perform an Achilles tendon lengthening in combination with a shortening of the tibialis anterior tendon [ 23 , 24 ]), toe-walkers who developed a clinically assessed asymmetrical passive hip internal rotation often require an additional femoral correction osteotomy, a much more invasive procedure. If the orthotic treatment started late, the foot may have developed an abducted flat-foot deformity which would be reconstructed in the same surgical session.…”

Section: Discussionmentioning

confidence: 99%

Restoration of Heel–Toe Gait Patterns for the Prevention of Asymmetrical Hip Internal Rotation in Patients with Unilateral Spastic Cerebral Palsy

2021

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Forward modelling has indicated hip internal rotation as a secondary physical effect to plantar flexion under load. It could therefore be of interest to focus the treatment for patients with unilateral spastic cerebral palsy on achieving a heel–toe gait pattern, to prevent development of asymmetrical hip internal rotation. The aim of this preliminary retrospective cohort investigation was to evaluate the effect of restoring heel–toe gait, through use of functional orthoses, on passive hip internal rotation. In this study, the affected foot was kept in an anatomically correct position, aligned to the leg and the gait direction. In case of gastrosoleus shortness, a heel raise was attached to compensate for the equinus and yet to provide heel–floor contact (mean equinus = −2.6 degrees of dorsiflexion). Differences in passive hip internal rotation between the two sides were clinically assessed while the hip was extended. Two groups were formed according to the achieved correction of their gait patterns through orthotic care: patients with a heel-toe gait (with anterograde rocking) who wore the orthosis typically for at least eight hours per day for at least a year, or patients with toe-walking (with retrograde rocking) in spite of wearing the orthosis who used the orthosis less in most cases. A Student’s t-test was used to compare the values of clinically assessed passive hip rotation (p < 0.05) between the groups and the effect size (Hedges’ g) was estimated. Of the 70 study participants, 56 (mean age 11.5 y, majority GMFCS 1, similar severity of pathology) achieved a heel-toe gait, while 14 remained as toe-walkers. While patients with heel–toe gait patterns showed an almost symmetrical passive hip internal rotation (difference +1.5 degrees, standard deviation 9.6 degrees), patients who kept toe-walking had an increased asymmetrical passive hip internal rotation (difference +10.4 degrees, standard deviation 7.5 degrees; p = 0.001, Hedges’s g = 0.931). Our clinical findings are in line with the indications from forward modelling that treating the biomechanical problem might prevent development of a secondary deformity. Further prospective studies are needed to verify the presented hypothesis.

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“…Step angle SA Parkinsonian [19,[69][70][71][72][73] Paraparetic (in scissors) [74][75][76][77][78] Dancer (typical of Korea) [79][80][81][82][83][84][85][86] Apraxic [20,[87][88][89] Ataxic (taloneant) [90][91][92][93] Ataxic (cerebellar) [94][95][96][97][98][99] Vestibular (star or compass) [100][101][102][103][104][105][106] Equinus (steppe) [107][108][109][110][111][112] Abnormalities associated with multisensory deficits [113][114][115]…”

Section: Stop Duration Sdmentioning

confidence: 99%

A Practical Review of the Biomechanical Parameters Commonly Used in the Assessment of Human Gait

González

Medellín-Castillo

Cervantes-Sánchez

et al.

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The analysis of human gait is a potential diagnostic instrument for the early and timely identification of pathologies and disorders. It can also supply valuable data for the development of biomedical devices such as prostheses, orthoses, and rehabilitation systems. Although various research papers in the literature have used human gait analyses, few studies have focused on the biomechanical parameters used. This paper presents an extensive review and analysis of the main biomechanical parameters commonly used in the human gait study. The aim is to provide a practical guide to support and understand of the choices and selection of the most appropriate biomechanical parameters for gait analysis. A comprehensive search in scientific databases was conducted to identify, review and analyze the academic work related to human gait analysis. From this search, the main biomechanical parameters used in healthy and pathological gait studies were identified and analyzed. The results have revealed that the spatiotemporal and angular gait parameters are the most used in the assessment of healthy and pathological human gait.

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Long-term follow-up after tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy

Cited by 24 publications

References 20 publications

Three-Dimensional Gait Analysis in Children Undergoing Gastrocsoleus Lengthening for Equinus Secondary to Cerebral Palsy

Three-Dimensional Gait Analysis in Children Undergoing Gastrocsoleus Lengthening for Equinus Secondary to Cerebral Palsy

Restoration of Heel–Toe Gait Patterns for the Prevention of Asymmetrical Hip Internal Rotation in Patients with Unilateral Spastic Cerebral Palsy

A Practical Review of the Biomechanical Parameters Commonly Used in the Assessment of Human Gait

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