Split Transfer of the Tibialis Anterior Tendon Combined With Calcaneocuboid Fusion vs Split Transfer of the Tibialis Anterior Tendon Alone to Treat Equinovarus Foot Deformity in Children With Cerebral Palsy

Abstract

Background: The study aimed to compare the outcomes of combined calcaneocuboid arthrodesis and split anterior tibialis tendon transfer (SPLATT) procedure to isolated SPLATT surgery for the treatment of the spastic equinovarus deformity in children with cerebral palsy (CCP). Methods: Forty-one ambulatory CCP with 56 equinovarus feet, with positive flexor withdrawal reflex test results, were studied. The average age was 9.1 ± 3.2 years (range 3-22). Patients were assigned into 2 groups based on the surgical procedures. Patients in group 1 underwent isolated SPLATT surgery, whereas patients in group 2 underwent the SPLATT procedure combined with calcaneocuboid arthrodesis. All feet were followed for at least 12 months after surgery. Patients were evaluated preoperatively and at the most recent follow-up visit. The hindfoot positions were assessed using Chang’s criteria, the functional outcomes were assessed using Kling’s criteria, and the ambulatory levels were assessed using the Gross Motor Function Classification System (GMFCS). Results: Patients were followed for an average of 30.4 ± 14 (range 14-84) months. We found no difference between the groups in Chang’s scoring ( P = .550), better clinical outcomes ( P = .034) according to the Kling criteria in SPLATT with calcaneocuboid fusion group, and postoperative GMFCS levels better in the SPLATT with calcaneocuboid fusion group ( P = .025). Conclusion: In this retrospective comparative study to treat children with spastic equinovarus feet, patients who had the SPLATT procedure combined with calcaneocuboid arthrodesis generally resulted in better functional outcomes compared to isolated SPLATT surgery in spastic equinovarus foot. Level of Evidence: Level III, retrospective cohort study.

Letter Regarding: Split Transfer of the Tibialis Anterior Tendon Combined With Calcaneocuboid Fusion vs Split Transfer of the Tibialis Anterior Tendon Alone to Treat Equinovarus Foot Deformity in Children With Cerebral Palsy

“…Equinovarus deformity is a common foot deformity that occurs in cerebral palsy which is due to a dynamic imbalance between the invertors and evertors leading gradually to a more fixed deformity. We read with interest the study by Bacaksız et al 1 on the role of calcaneocuboid fusion (CCF) along with split tibialis anterior tendon transfer (STATT) in such children. The authors concluded that addition of CCF to a STATT procedure generally resulted in better functional outcomes in comparison to isolated STATT procedure in a spastic equinovarus foot.…”