Single procedure tibialis anterior tendon shortening in combination with Achilles tendon lengthening in unilateral cerebral palsy improves swing phase dorsiflexion in gait.

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2024-04-29 eCollection Date: 2024-08-01 DOI:10.1177/18632521241244624
Michèle Widmer, Monica Staganello, Morgan Sangeux, Marco Odorizzi, Reinald Brunner, Elke Viehweger
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Abstract

Purpose: Tibialis anterior tendon shortening combined with tendon Achilles lengthening showed satisfactory short- and long-term outcomes for pes equinus treatment. This retrospective study aimed to evaluate the effectiveness of a single tibialis anterior tendon shortening-tendon Achilles lengthening procedure for treating pes equinus, in a homogeneous unilateral cerebral palsy patient group.

Methods: Gait analysis was conducted on 22 unilateral cerebral palsy patients (mean age at surgery = 13.3 years, standard deviation = 3 years) before and within 2.5 years (standard deviation = 0.61 years) after the tibialis anterior tendon shortening-tendon Achilles lengthening procedure. Primary outcome measures included foot drop occurrence in swing, foot dorsiflexion and the first ankle rocker presence compared to healthy reference data. Movement analysis profile and gait profile score were also calculated for the entire gait cycle. The clinical exam and the A2 peak ankle power were analyzed. Statistical analysis used the paired Wilcoxon's sign rank test (p < 0.05).

Results: Post-operatively, significant improvements were observed in ankle dorsiflexion during swing (p = 0.0006) and reduced foot drop in swing (p = 0.0107). The occurrence of a first ankle rocker did not significantly change (p = 0.1489). Significant improvements in gait profile score and movement analysis profile for all joints and planes indicate overall gait quality improvement. The foot progression changed significantly (p = 0.0285), with a greater external orientation. Nineteen out of 22 patients were able to quit wearing their ankle foot orthoses.

Conclusion: Tibialis anterior tendon shortening and tendon Achilles lengthening combination yielded positive outcomes, showing increased foot dorsiflexion, first ankle rocker presence, and overall improved gait quality. These findings support the effectiveness of this surgical approach for treating pes equinus in children with unilateral spastic cerebral palsy.

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单侧脑瘫患者的胫骨前肌腱缩短术与跟腱延长术联合使用可改善步态摆动阶段的外展。
目的:胫骨前肌腱缩短术联合跟腱延长术治疗马蹄内翻足的短期和长期疗效令人满意。这项回顾性研究旨在评估胫骨前肌腱缩短-肌腱跟腱延长术治疗马蹄内翻足的疗效:对 22 名单侧脑瘫患者(手术时平均年龄为 13.3 岁,标准差为 3 岁)进行了步态分析,包括胫骨前肌腱缩短-跟腱延长术前和术后 2.5 年内(标准差为 0.61 年)。主要结果指标包括与健康参考数据相比的摆动中的足下垂发生率、足外翻率和第一踝摇摆率。此外,还计算了整个步态周期的运动分析轮廓和步态轮廓得分。对临床检查和 A2 峰值踝关节力量进行了分析。统计分析采用配对 Wilcoxon 符号秩检验(P 结果:术后观察发现,摆动时的踝关节外展(p = 0.0006)和摆动时的足下垂(p = 0.0107)均有明显改善。第一次踝关节摇摆的发生率没有明显变化(p = 0.1489)。所有关节和平面的步态剖面得分和运动分析剖面均有明显改善,这表明步态质量总体上有所提高。足部前移发生了明显变化(p = 0.0285),外侧方向更大。22名患者中有19名能够放弃佩戴踝足矫形器:结论:胫骨前肌腱缩短术和跟腱延长术的联合应用产生了积极的效果,足背屈增加,第一踝摇摆出现,步态质量总体改善。这些研究结果表明,这种手术方法对治疗单侧痉挛性脑瘫患儿的 "马蹄内翻足 "非常有效。
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来源期刊
Journal of Childrens Orthopaedics
Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
2.70
自引率
14.30%
发文量
61
审稿时长
23 weeks
期刊介绍: Aims & Scope The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery. It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents. The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology. The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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