Outcome of gastrocnemius recession and tendo-achilles lengthening in ambulatory children with cerebral palsy

Abstract

Preoperative and postoperative gait analysis data were retrospectively studied for 54 children with cerebral palsy who had undergone either gastrocnemius recession (GR) or tendo-achilles lengthening (TAL) as part of multi-level surgery. Decision-making between GR and TAL was based on the Silfverskiöld test. The TAL group had greater equinus preoperatively than the GR group. Both groups showed significant improvement in static and dynamic dorsiflexion and in outcome measured by a modified Physician Rating Scale (PRS) postoperatively. Calf spasticity decreased and push-off power increased after GR. Both GR and TAL are effective in appropriately selected patients. However, a potential for over- and under-correction with both GR and TAL was demonstrated.

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

“…Overcorrection or calcaneal gait at long-term follow-up has been reported as 4% in children with USCP and 3-11% in children with BSCP [9,11,15,16]. However, it should be noted that Klausler et al did not provide a definition for recurrent equinus, overcorrection or calcaneal gait, which have been variably defined across studies [15,28,35].…”

“…Fourteen studies reported swing phase kinematics [4,9,10,12,14,18,21,[23][24][25][26]33,35,36]. All studies reported significant increases in maximum or mean swing phase ankle dorsiflexion.…”

A Prospective Cohort Study of the Effects of Lower Extremity Orthopaedic Surgery on Outcome Measures in Ambulatory Children With Cerebral Palsy

“…Considerable evidence exists for the short-term impact of individual procedures on gait, such as rectus femoris transfer,12–21 hamstring lengthening,12–14,16,21–30 and heelcord lengthening 14,29,31–36. These are based on retrospective, uncontrolled studies with small sample sizes focusing on gait variables and clinical examination measures.…”

Transmetatarsal Amputation: A Case Series and Review of the Literature

“…Additionally, where tightness of soleus is not an issue with adequate dorsiflexion at the ankle possible with the knee flexed, lengthening of the Achilles may be seen to unnecessarily weaken the gastrocnemius-soleus complex. Gastrocnemius recession has also been shown to result in superior push-off power with lesser risk of recurrence of equinus in comparison to TAL in cerebral palsy patients [16, 17]. …”