Operative Treatment of Cerebral Palsy of Spastic Type

Green, William T.; McDERMOTT, Leo J.

doi:10.1001/jama.1942.02830060014004

Cited by 32 publications

(8 citation statements)

References 7 publications

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“…In addition to identifying sites for increased risk of rupture, an understanding of the arterial supply of the tendon is also paramount to describing approaches to the tendon during surgery. These situations include for harvest as use as a vascularized tendon graft, and for surgical lengthening of the Achilles tendon in the correction of ankle equinus (Green, 1942;Graham and Fixsen, 1988;Goldstein and Harper, 2001;Dietz et al, 2006). Understanding the precise arterial supply of the Achilles tendon is essential in these settings, as minimizing tendon damage can maximize operative success and aid healing and subsequent function.…”

Section: Introductionmentioning

confidence: 99%

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

et al. 2009

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The Achilles tendon is the most frequently ruptured tendon in the lower limb and accounts for almost 20% of all large tendon injuries. Despite numerous published studies describing its blood supply, there has been no uniformity in describing its topography. The current study comprises a detailed anatomical study of both the intrinsic and extrinsic arterial supply of the Achilles tendon, providing the detail sought from studies calling for improved planning of surgical procedures where damage to the vascularity of the Achilles tendon is likely. A dissection, microdissection, histological, and angiographic study was undertaken on 20 cadaveric lower limbs from 16 fresh and four embalmed cadavers. The Achilles tendon is supplied by two arteries, the posterior tibial and peroneal arteries. Three vascular territories were identified, with the midsection supplied by the peroneal artery, and the proximal and distal sections supplied by the posterior tibial artery. The midsection of the Achilles tendon was markedly more hypovascular that the rest of the tendon. The Achilles tendon is at highest risk of rupture and surgical complications at its midsection. Individuals with particularly poor supply of the midsection may be at increased risk of tendon rupture, and approaches to the tendon operatively should consider the route of supply by the peroneal artery to this susceptible part of the tendon.

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Section: Introductionmentioning

confidence: 99%

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

et al. 2009

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“…Failure of conservative treatment such as physiotherapy, ankle foot orthoses, casting, and injections of botulinum toxin A may be an indication for surgical intervention. 7,8 Many surgical procedures have been described for the treatment of this deformity including partial neurectomy of the gastrocnemius, 9,10 lengthening of the origin of the gastrocnemius, 11,12 recession of the proximal gastrocnemius aponeurosis, 13 combined lengthening of the gastrocnemius/ soleus fascia, [14][15][16] and lengthening 4,[17][18][19] and translocation 20 of tendo Achillis. Previous studies have reported recurrent equinus in approximately 10% to 30% of patients with hemiplegia 5,21 and calcaneus in 3% to 30% of patients with diplegia.…”

mentioning

confidence: 99%

Isolated calf lengthening in cerebral palsy

Borton

Walker

Pirpiris

et al. 2001

The Journal of Bone and Joint Surgery. British volume

107

130

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We reviewed 195 procedures in 134 children; 45 had hemiplegia, 65 diplegia and 24 quadriplegia. We established the incidence of calcaneus and recurrent equinus and identified 'at-risk' groups for each. At follow-up, 42% had satisfactory calf length, 22% had recurrent equinus and 36% calcaneus. The incidence of calcaneus in girls at follow-up was significantly higher (p = 0.002) while boys had an increased rate of recurrent equinus (p = 0.012).Children with diplegia who had surgery when aged eight years or younger had a 44% risk of calcaneus, while those over eight years had a 19% risk (p = 0.046). Percutaneous lengthening of tendo Achillis in diplegia was the least predictable, only 38% having a satisfactory outcome compared with 50% in the other procedures.The incidence of recurrent equinus in hemiplegic patients was 38%. Only 4% developed calcaneus. The type of surgery did not influence the outcome in patients with hemiplegia or quadriplegia.Severity of involvement, female gender, age at operation of less than eight years and percutaneous lengthening of tendo Achillis were 'risk factors' for calcaneus. Hemiplegia, male gender, and an aponeurosis muscle lengthening increased the risk of recurrent equinus.

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“…To obtain suppression of myotony, improvement of articular contracture, propulsion of walking, or improvement of the walking condition, we perform surgery. In patients with a bending or adducent contracture of more than 30° observed in the hip joint by the Thomas test, detachment of muscles around the hip joint, such as incision of adductor muscles, and extension of iliopsoas muscles and rectus muscles of the thigh, was performed [5,6]. In the knee joint with a bending contracture of more than 30° in the supine position, medial hamstring muscles were partially extended [7], and detachment of the distal lacertus of gastrocnemius muscles (Baker, Vulpius method) was performed in the ankle joint with a dorsiflexion angle of less than 0° in the passive incomplete extension of the knee [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional gait analysis of cerebral paralysis patients after operation and effect of orthoses

Ito¹

2017

Res Rev Insights

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Three-dimensional gait analysis in 6 patients with spastic type of bilateral cerebral palsy was performed in this study. We evaluated the extension angle of the hip joint in the late stance phase, extension moment of the hip joint in the middle stance phase, and plantar flexion moment of the ankle joint in the late stance phase. The characteristics of walking after surgery were poor extension of the hip joint, reduction of extension moment of the hip joint compared to that during steady walking. In 3 of the 6 patients, the maximal extension moment was increased by fixation of the orthosis, though extension of the hip joint was not obtained even by fixation of the orthosis.In 4 of the 6 patients, the plantar flexion moment of the ankle joint was increased by fixation of the orthosis, though reduction of plantar flexion moment in the middle stance phase was observed compared to that of steady walk. Objective evaluation of changes in the walking condition before and after application of orthoses was possible by this method.

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Operative Treatment of Cerebral Palsy of Spastic Type

Cited by 32 publications

References 7 publications

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

Isolated calf lengthening in cerebral palsy

Three-dimensional gait analysis of cerebral paralysis patients after operation and effect of orthoses

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