Abstract
To evaluate the outcome of combined tibialis anterior tendon shortening (TATS) and calf muscle-tendon lengthening (CMTL) in spastic equinus.
Prospectively collected data was analysed in 26 patients with hemiplegic (n=13) and diplegic (n=13) cerebral palsy (CP) (GMFCS level I or II, 14 males, 12 females, age range 10–35 years; mean 16.8 years). None had received botulinum toxin A injections or surgery in the preceding six and 12 months respectively. All patients had pre-operative 3D gait analysis and a further analysis at a mean of 17.1 months (± 5.6months) after surgery. None was lost to follow-up. Twenty-eight combined TATS and CMTL were undertaken and 19 nineteen patients had additional synchronous multilevel surgery. At follow-up 79% of patients had improved foot positioning at initial contact. Statistically significant improvements were seen in the Movement Analysis Profile for ankle dorsi-/plantarflexion (4.25, p=0.032), maximum ankle dorsiflexion during swing phase (11.68°, p<0.001), and Edinburgh Visual Gait Score (EVGS) (4.85, p=0.014). Diplegic patients had a greater improvement in the EVGS than hemiplegics (6.27 -vs- 2.21, p = 0.024).
The originators of combined TATS and CMTL showed that it improved foot positioning during gait. The present study has independently confirmed favourable outcomes in a similar patient population and added additional outcome measures, the EVGS, foot positioning at initial contact, and maximum ankle dorsiflexion during swing phase. Study limitations include short term follow-up in a heterogeneous population and that 19 patients had additional surgery. However, distinguishing between the natural history of CP and interventions and isolating the effects of one intervention from others in multilevel surgery are well recognised difficulties in cohort studies in CP. TATS combined with CMTL is a recommended option for spastic equinus in ambulatory patients with CP.
