Takaki K1, Matsuo A2, Kusumoto Y3
1Mejiro University, Physical Therapy, Saitama, Japan, 2Kasuyashinkouen, Orthopedics, Fukuoka, Japan, 3Tokyo University of Technology, Physical Therapy, Tokyo, Japan
Background: Equinus deformity a common deformity in children with cerebral palsy (CP). Soft-tissue release surgery is the most common surgery in Japan. When the lengthening of Achilles tendon (AT) or release of the gastrocnemius muscle by the Vulpius method is conducted to address equinus deformity, the tibialis posterior muscle, the peroneus longus muscle, and the flexor digitorum longus muscles are released at the same time to reduce the lengthening of the AT and gastrocnemius muscle. Some patients had recurrence of equinus deformity or calcaneal deformity.
Purpose: The aim of our study is to reveal the percentage of additional re-operation for recurrence of the equinus deformity and calcaneal deformity and to clarify the relationship between the period until reoperation and predisposing factor.
Methods: In this retrospective study, 290 children (190 males, 100 females, with a mean age of 8.74 ± 3.56) with spastic CP, who underwent soft-tissue release surgery (the combination of the lengthening of the AT and Vulpius method or Vulpius method alone) at our hospital between 2002 and 2014 were enrolled.
Soft-tissue release surgery was performed bilaterally and defined as re-operations for equinus deformity recurrence. When the tibialis anterior muscle, the peroneus brevis muscle, or the peroneus tertius muscle were released to increase ankle torque plantar flexion after the first operation, it was defined as re-operation for calcaneal deformity.
SPSS ver.24 was used for statistical analyses. The log-rank test, concerning the Gross Motor Function Classification System (GMFCS) level and type of paralysis, was carried out according to type of additional re-operation.
This study was approved by Mejiro University Ethics Review Board.
Results: Of the total patients, 7.2% (21/290) had an operation for recurrent equinus deformity and 5.5％ (16/290 people) had an operation for calcaneal deformity.
In children who underwent additional re-operation for equinus deformity recurrence, 8.7% (8/92) had GMFCS level I; 15.5% (8/55) had II; 8.2% (5/61) had III; 0% (0/72) had IV; and 0% (0/10) had V. Types of hemiplegia in children with CP was 8.1% (4/66), diplegia in 9.4% (16/171), and quadriplegia in 1.8% (1/55).
Those who underwent re-operation for calcaneal deformity, 1.1% (1/92 people) had GMFCS I, 1.8% (1/55 people) had II, 8.2% (5/61 people) had III, 12.5% (9/72 people) had IV, and 0% (0/10 people) had V. Types of hemiplegia in children with CP was 1.5% (1/66 people), diplegia in 3.5% (6/171 persons), and quadriplegia in 18.4% (9/55 people).
There was a significant difference in the GMFCS (p＜0.05) until re-operation for the recurrence of equinus deformity and calcaneal deformity. There was a significant difference in the calcaneal deformity according to paralysis type.
Conclusion(s): Re-operation for equinus deformity recurrence is performed on ambulatory children with CP. Re-operation for calcaneal deformity is performed on children who are non-ambulatory or are quadriplegic.
Implications: This result will assist in the planning of the rehabilitation program. We need to formulate a program that considers the GMFCS level and paralysis type to reduce additional re-operation.
Keywords: cerebral palsy, soft-tissue release surgery, GMFCS
Funding acknowledgements: We thank patients and their family for their participation.
Purpose: The aim of our study is to reveal the percentage of additional re-operation for recurrence of the equinus deformity and calcaneal deformity and to clarify the relationship between the period until reoperation and predisposing factor.
Methods: In this retrospective study, 290 children (190 males, 100 females, with a mean age of 8.74 ± 3.56) with spastic CP, who underwent soft-tissue release surgery (the combination of the lengthening of the AT and Vulpius method or Vulpius method alone) at our hospital between 2002 and 2014 were enrolled.
Soft-tissue release surgery was performed bilaterally and defined as re-operations for equinus deformity recurrence. When the tibialis anterior muscle, the peroneus brevis muscle, or the peroneus tertius muscle were released to increase ankle torque plantar flexion after the first operation, it was defined as re-operation for calcaneal deformity.
SPSS ver.24 was used for statistical analyses. The log-rank test, concerning the Gross Motor Function Classification System (GMFCS) level and type of paralysis, was carried out according to type of additional re-operation.
This study was approved by Mejiro University Ethics Review Board.
Results: Of the total patients, 7.2% (21/290) had an operation for recurrent equinus deformity and 5.5％ (16/290 people) had an operation for calcaneal deformity.
In children who underwent additional re-operation for equinus deformity recurrence, 8.7% (8/92) had GMFCS level I; 15.5% (8/55) had II; 8.2% (5/61) had III; 0% (0/72) had IV; and 0% (0/10) had V. Types of hemiplegia in children with CP was 8.1% (4/66), diplegia in 9.4% (16/171), and quadriplegia in 1.8% (1/55).
Those who underwent re-operation for calcaneal deformity, 1.1% (1/92 people) had GMFCS I, 1.8% (1/55 people) had II, 8.2% (5/61 people) had III, 12.5% (9/72 people) had IV, and 0% (0/10 people) had V. Types of hemiplegia in children with CP was 1.5% (1/66 people), diplegia in 3.5% (6/171 persons), and quadriplegia in 18.4% (9/55 people).
There was a significant difference in the GMFCS (p＜0.05) until re-operation for the recurrence of equinus deformity and calcaneal deformity. There was a significant difference in the calcaneal deformity according to paralysis type.
Conclusion(s): Re-operation for equinus deformity recurrence is performed on ambulatory children with CP. Re-operation for calcaneal deformity is performed on children who are non-ambulatory or are quadriplegic.
Implications: This result will assist in the planning of the rehabilitation program. We need to formulate a program that considers the GMFCS level and paralysis type to reduce additional re-operation.
Keywords: cerebral palsy, soft-tissue release surgery, GMFCS
Funding acknowledgements: We thank patients and their family for their participation.
Topic: Paediatrics: cerebral palsy; Paediatrics
Ethics approval required: Yes
Institution: Mejiro University
Ethics committee: Mejiro University Ethics review committee on research for people
Ethics number: 18-033
All authors, affiliations and abstracts have been published as submitted.
