Outcomes of isolated soft tissue surgery for in-toeing gait in patients with ambulatory cerebral palsy.
Cerebral palsy
Gait analysis
Hip
Hip internal rotation
Muscle contracture
Spasticity
Walking
Journal
Orthopaedics & traumatology, surgery & research : OTSR
ISSN: 1877-0568
Titre abrégé: Orthop Traumatol Surg Res
Pays: France
ID NLM: 101494830
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
14
04
2019
revised:
11
06
2020
accepted:
19
06
2020
pubmed:
4
10
2020
medline:
10
6
2021
entrez:
3
10
2020
Statut:
ppublish
Résumé
Soft tissue surgery to address in-toeing gait in young cerebral palsy (CP) patients may be an alternative in some cases to femoral derotation osteotomy (FDO), which is the currently accepted treatment. The relative contribution of muscular contracture, spasticity and bone deformity is still controversial. In this study, we determined the outcomes of soft tissue surgery on hip internal rotation (HIR) when femoral anteversion was less than 45° and the soft tissues were identified as being the cause. This prospective study included select adolescent patients who were operated in the context of single-event multilevel surgery. The soft tissues' contribution to the HIR was identified beforehand. The surgical procedures focused on the hamstrings, adductor magnus and gluteus minimus muscles. Over a 6-year period, 21 patients (mean age 14 years) and 25 lower limbs were treated. The HIR improved by an average of 17.4°±4.8° (95% CI). The gait deviation index and gait profile score also improved significantly. At a mean follow-up of 36 months, no loss of correction had occurred. In-toeing gait in CP patents is due to the action of retracted and/or spastic muscles and the presence of excessive bone torsion. When femoral anteversion<45°, confirming soft tissue involvement allows us to do a surgical procedure on the soft tissues only to correct the dynamic aspect of HIR. Our findings suggest that, under the right conditions, soft tissue surgery can improve in-toeing gain in the long term. This technique has its place alongside FDO in certain CP patients who do not have severe femoral anteversion.
Sections du résumé
BACKGROUND
BACKGROUND
Soft tissue surgery to address in-toeing gait in young cerebral palsy (CP) patients may be an alternative in some cases to femoral derotation osteotomy (FDO), which is the currently accepted treatment. The relative contribution of muscular contracture, spasticity and bone deformity is still controversial. In this study, we determined the outcomes of soft tissue surgery on hip internal rotation (HIR) when femoral anteversion was less than 45° and the soft tissues were identified as being the cause.
METHODS
METHODS
This prospective study included select adolescent patients who were operated in the context of single-event multilevel surgery. The soft tissues' contribution to the HIR was identified beforehand. The surgical procedures focused on the hamstrings, adductor magnus and gluteus minimus muscles.
RESULTS
RESULTS
Over a 6-year period, 21 patients (mean age 14 years) and 25 lower limbs were treated. The HIR improved by an average of 17.4°±4.8° (95% CI). The gait deviation index and gait profile score also improved significantly. At a mean follow-up of 36 months, no loss of correction had occurred.
DISCUSSION
CONCLUSIONS
In-toeing gait in CP patents is due to the action of retracted and/or spastic muscles and the presence of excessive bone torsion. When femoral anteversion<45°, confirming soft tissue involvement allows us to do a surgical procedure on the soft tissues only to correct the dynamic aspect of HIR. Our findings suggest that, under the right conditions, soft tissue surgery can improve in-toeing gain in the long term. This technique has its place alongside FDO in certain CP patients who do not have severe femoral anteversion.
Identifiants
pubmed: 33008781
pii: S1877-0568(20)30246-2
doi: 10.1016/j.otsr.2020.06.008
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1367-1371Informations de copyright
Copyright © 2020 Elsevier Masson SAS. All rights reserved.