Rocha GA, López VA, Hutchinson B, Southerland C, Kashuk K, Hatch D, Dockery D, Sosa CJ, Esperón HR

Language: Spanish
References: 18
Page: 72-79
PDF size: 197.74 Kb.

ABSTRACT

Introduction: Neurospastic ankle equinus is one of the most common and disabling condition in children with cerebral palsy. A 10° deformity in plantar flexion of the ankle is enough to disturb the gait and the limb biomechanics. Several techniques for correction are reported; two of them achilles advancement (Murphy technique) and Achilles fractional lengthening with controversial results on the literature. The objective of this study was to evaluate functional results on our Institution with these two techniques applied on two uniform groups to correct neurospastic equinus. Methods: Retrospective analysis of functional results for correction of neurospastic equinus with Achilles advancement (Murphy) or Achilles Fractional Lengthening (TAL) of surgeries performed from 1998 to 2012 at our Institution, using Functional Mobility Score (FMS), Physician Rating Scale PRS and Edimburgo visual gait analysis. Results were compared using t Student and we also performed a cost benefit analysis considering the success and the relapse rates. Results: Twenty-five patients were includes (12 feet with Murphy and 13 with TAL). Murphy group 7.55 years mean age, mean difference for dorsiflexion 43°, FMS preop. 8.25 pts, postop. 14.75 pts. Edimburgo preop. 38.3 pts, postop. 26.91 pts; 91.7% success rate and one relapse (8.3%) TAL group 6.69 years mean age, mean difference for dorsiflexion 31°, FMS preop. 9.38 pts, postop. 14.53 pts. Edimburgo preop. 40.46 pts., postop. 11.38 pts., 38.3% success rate, and two relapses (15.38%) and three Achilles insufficiencies (23.07%), Murphy patients stopped using orthoses and had no insufficiencies, performing better cost-benefit. Discussion: Murphy and Pierrot reported 81% success with HCA, at our Institution it was higher, and we also had no patients using orthoses after surgery. Borton and colleagues studied 195 procedures in 134 children with neurospastic equinus corrected by TAL, they found 58% of Achilles insufficiency which determined a calcaneovalgus and crouch gait in these children. We found the biomechanic explanation of our results in Southerland’s paper,9 which states that HCA does not changes the architecture of Achilles, but enhaces it’s lever arm by modifying the insertion place. Conclusions: Heel cord advancement with modified Murphy technique reported better results, less relapse and complications than percutaneous Achilles tendon lengthening to correct neurospastic foot equinus in children at our Institution.

REFERENCES

1. Throop FB, DeRosa GP, Reeck C, Waterman S. Correction of equinus in cerebral palsy by the Murphy procedure of tendo calcaneus advancement: a preliminary communication. Dev Med Child Neurol. 1975; 17(2): 182-185.

2. Strecker WB, Via MW, Oliver SK, Schoenecker PL. Heel cord advancement for treatment of equinus deformity in cerebral palsy. J Pediatr Orthop. 1990; 10(1): 105-108.

3. Yoshimoto M, Kura H, Matsuyama T, Sasaki T, Yamashita T, Ishii S. Heel cord advancement combined with Vulpius’ lengthening of the gastrocnemius. Clin Orthop Relat Res. 2005; (434): 213-216.

4. McGlamry E, Downey M. Anterior advancement of the tendo achillis. Journal of the American Podiatric Medical Association. 1987; 77(3): 117-122.

5. Jay RM, Schoenhaus HD. Further insights in the anterior advancement of tendo achillis. J Am Podiatry Assoc. 1981; 71(2): 73-76.

6. Smith SD, Weil LS. Anterior advancement of the tendo achillis for spastic equinus deformity. J Am Podiatry Assoc. 1974; 64(12): 1016-1023.

7. Borton DC, Walker K, Pirpiris M, Nattrass GR, Graham HK. Isolated calf lengthening in cerebral palsy. Outcome analysis of risk factors. J Bone Joint Surg Br. 2001; 83(3): 364-370.

8. Dietz FR, Albright JC, Dolan L. Medium-term follow-up of Achilles tendon lengthening in the treatment of ankle equinus in cerebral palsy. Iowa Orthop J. 2006; 26: 27-32.

9. Lofterød B, Terjesen T. Local and distant effects of isolated calf muscle lengthening in children with cerebral palsy and equinus gait. J Child Orthop. 2008; 2(1): 55-61.

10. Southerland CC, Kashuk KB, Dockery GL, Rocha A, Hutchinson B, Sosinski M. A retrospective analysis of tendo-achilles advancement in comparison to tendo-achilles lengthening in cases of pediatric neurospastic equines. ACFAP Quarterly Summer. 2016; 18-23.

11. Strecker WB, Via MW, Oliver SK, Schoenecker PL. Heel cord advancement for treatment of equinus deformity in cerebral palsy. J Pediatr Orthop. 1990; 10(1): 105-108.

12. Yoshimoto M, Kura H, Matsuyama T, Sasaki T, Yamashita T, Ishii S. Heel cord advancement combined with Vulpius’ lengthening of the gastrocnemius. Clin Orthop Relat Res. 2005; (434): 213-216.

13. Walker JL, Stevens DB, Clark NS, Opfell AR. Heel cord advancement in children with spastic equinus deformity. Foot Ankle Int. 1994; 15(10): 536-540.

14. McGlamry E, Downey M. Anterior advancement of the tendo achillis. Journal of the American Podiatric Medical Association. 1987; 77(3): 117-122.

15. Febrer i Carretero L, Iglesias-García C, Mercadal-Dalmau J, Ribera-Pibernat M. Cómo entender un análisis de coste-efectividad. Piel. 2005; 20(4): 172-176.

16. Rovira J, Antoñanzas F. Economic analysis of health technologies and programmes. A Spanish proposal for methodological standardisation. Pharmacoeconomics. 1995; 8(3): 245-252.

17. Siegel JE, Weinstein MC, Russell LB, Gold MR. Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine. JAMA. 1996; 276(16): 1339-1341.

18. Reynolds J, Gaspari KC. Aanálisis de costo efectividad. Chevy Chase Maryland USA: Center For Human Services; 1985.