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Cerebral palsy tenotomy

Bruno Dohin, Elie Haddad, Hassan Al Khoury Salem, Mohamed Merhez Kilani
OBJECTIVE: Hip internal rotation (HIR) during gait is one of the main functional disorders related to cerebral palsy (CP) in children. Most of the procedures proposed rotational osteotomy of the femur (FRO), (and/or tibia). However, multilevel surgery (SEMLS) including bone procedure, implicates more difficult and longer rehabilitation. When bone deformity is moderate, the authors hypothesized that FRO could be avoided. They developed a soft tissues procedure to improve HIR. The aim of the study was assessment of the procedure...
September 2016: Annals of Physical and Rehabilitation Medicine
Flavia Coroian, Bertrand Coulet, Claire Jourdan, Olivier Choquet, Isabelle Laffont
OBJECTIVE: The musculotendinous retractions are common complications of central neurological damage with consequences for comfort and function. Treatment of uncomfortable retractions is often surgical, mainly based on tendon gestures. The objective of this study was to evaluate the efficiency of percutaneous needle tenotomy in these indications. MATERIAL/PATIENTS AND METHODS: The indication was accepted at a medical-surgical consultation. Tenotomy was performed using an 18 Gauge needle...
September 2016: Annals of Physical and Rehabilitation Medicine
Christian A Refakis, Keith D Baldwin, David A Spiegel, Wudbhav N Sankar
BACKGROUND: Although many studies have separately investigated the treatment of developmental dysplasia of the hip and spastic hip disease, little data exist regarding the treatment of infants with dislocated hips and underlying spasticity. The purpose of this study was to review our results after the surgical treatment of these infants. METHODS: We retrospectively reviewed all children below 3 years of age who underwent hip reconstruction for dislocated hips in the setting of cerebral palsy or other spastic/high-tone neuromuscular disease...
July 2, 2016: Journal of Pediatric Orthopedics
Kerstin Reidy, Christoph Heidt, Stefan Dierauer, Hanspeter Huber
BACKGROUND: Hip reconstructive surgery in cerebral palsy (CP) patients necessitates either femoral varus derotational osteotomy (VDRO) or pelvic osteotomy, or both. The purpose of this study is to review the results of a moderate varisation [planned neck shaft angle (NSA) of 130°] in combination with pelvic osteotomy for a consecutive series of patients. METHODS: Patients with CP who had been treated at our institution for hip dysplasia, subluxation or dislocation with VDRO in combination with pelvic osteotomy between 2005 and 2010 were reviewed...
August 2016: Journal of Children's Orthopaedics
Maximilian Martinez, Seung-Ju Kim, Sanjeev Sabharwal
BACKGROUND: Treatment of a painful, chronically dislocated hip in nonambulatory children with cerebral palsy (CP) is challenging and controversial. Although many surgical options have been described, there is limited information, including patient-centered outcomes, following treatment. The purpose of our study was to evaluate the effect of a percutaneous subtrochanteric valgus osteotomy (SVO) using external fixation (EF) on hip abduction, radiographic parameters, and quality of life (QOL) measures in such patients...
July 24, 2015: Journal of Pediatric Orthopedics
İlker Abdullah Sarıkaya, Muharrem İnan, Ali Şeker
OBJECTIVE: The aim of this study was to determine the efficacy of semitendinosus and gastrocnemius tenotomies on popliteal angle presenting knee flexion spasticity in children with cerebral palsy (CP). METHODS: The study included 44 patients (25 males, 19 females; mean age: 8.1 years, range: 4 to 14 years) with spastic CP who underwent surgery for knee flexion spasticity. A total of 78 semitendinosus tenotomies and 28 associated gastrocnemius tenotomies were performed...
2015: Acta Orthopaedica et Traumatologica Turcica
Zoran Bozinovski, Neron Popovski
INTRODUCTION: Knee flexion is one of the main problems of the lower extremities in cerebral palsy patients. Many operative procedures are recommended for contractures of the knee in cerebral palsy patients. We performed simple operation and analyzed the results after operative treatment with nine years follow up. METHOD: 85 patients with spastic cerebral palsy were treated in period 2001 - 2010. 40 were ambulatory and 45 non ambulatory with ability to stand with support...
June 2014: Medical Archives
Pedro Gutierrez Carbonell
PURPOSE: Our objective was to study the pressure of the posterior superficial compartment of legs of children with spastic cerebral palsy and equinus deformity before and after a percutaneous tenotomy of the Achilles tendon. METHODS: We studied compartmental pressure in 28 percutaneous tenotomies of the Achilles tendon (18 patients). All patients suffered cerebral palsy: 19 were tetraplegics (67.9%) (Ashworth Grade 4, Gross Motor Function Classification System (GMFCS) Level IV), and 9 were hemiplegics (32...
February 2015: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Mathias Haefeli, Maurizio Calcagni
Spastic hemiplegia and cerebral palsy often lead to typical deformities of the upper extremity. Muscle- and joint-contractures may be painful and aesthetically unappealing and may interfere with function and hygiene. Within the first weeks after the cerebral incidence the vital threat is dominating and the exact amount of neurologic impairment is not assessable. During this period, conservative treatment should counteract the development of contractures. After spontaneous neurologic recovery, surgical options should be taken into account...
September 17, 2014: Praxis
Zoran Bozinovski, Neron Popovski
INTRODUCTION: Knee flexion is one of the main problems of the lower extremities in cerebral palsy patients. Many operative procedures are recommended for contractures of the knee in cerebral palsy patients. We performed simple operation and analyzed the results after operative treatment with nine years follow up. METHOD: 85 patients with spastic cerebral palsy were treated in period 2001-2010. 40 were ambulatory and 45 non ambulatory with ability to stand with support...
2014: Medicinski Arhiv
Troy J Boffeli, Rachel C Collier
Intrinsic plus foot deformity has primarily been associated with cerebral palsy and involves spastic contracture of the intrinsic musculature with resultant toe deformities. Digital deformity is caused by a dynamic imbalance between the intrinsic muscles in the foot and extrinsic muscles in the lower leg. Spastic contracture of the toes frequently involves curling under of the lesser digits or contracture of the hallux into valgus or plantarflexion deformity. Patients often present with associated pressure ulcers, deformed toenails, shoe or brace fitting challenges, and pain with ambulation or transfers...
September 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
A Tinney, A Khot, N Eizenberg, R Wolfe, H K Graham
Lengthening of the conjoined tendon of the gastrocnemius aponeurosis and soleus fascia is frequently used in the treatment of equinus deformities in children and adults. The Vulpius procedure as described in most orthopaedic texts is a division of the conjoined tendon in the shape of an inverted V. However, transverse division was also described by Vulpius and Stoffel, and has been reported in some clinical studies. We studied the anatomy and biomechanics of transverse division of the conjoined tendon in 12 human cadavers (24 legs)...
June 2014: Bone & Joint Journal
Lisa C Drefus, Melanie A Buckland, Sherry I Backus, Leon Root
The purpose of this study was to determine the effect of a distal rectus femoris tenotomy on function and gait in adults with cerebral palsy who had diminished knee flexion during swing. A stiff knee gait pattern is commonly seen in individuals with cerebral palsy and frequently leads to tripping and falling. Five subjects, 25-51 years, (34.6±10.3 years) participated in the study; each individual had the surgery after the age of 18. Four of the five subjects underwent bilateral distal rectus femoris tenotomies for a total of nine limbs being studied...
2014: Gait & Posture
E De Pavía-Mota, S Neri-Gámez, G Reyes-Contreras, M Valencia-Posadas
UNLABELLED: Knee flexor muscle contracture is frequent in patients with spastic cerebral palsy. The purpose of the study was to determine whether percutaneous tenotomy and aponeurotomy may decrease knee flexor contracture in children with spastic cerebral palsy. MATERIAL AND METHODS: A prospective study of consecutive cases was conducted from January to December 2009 in 24 children with a diagnosis of moderate to severe spastic cerebral palsy who had knee flexor contracture with a popliteal angle > or = 45 degrees and a gross motor function classification scale of 4 or 5; they underwent percutaneous tenotomy and aponeurotomy surgery and were followed-up for 24 months...
March 2013: Acta Ortopédica Mexicana
Erik J Carlson, Michelle Gerwin Carlson
Swan neck deformity in patients with cerebral palsy can result from hand intrinsic muscle spasticity or overpull of the digital extensors. After accurate identification of the etiology of the deformity, surgical treatment is directed at correcting the underlying muscle imbalance. Intrinsic lengthening can be used to treat intrinsic muscle spasticity, whereas central slip tenotomy is employed when digital extensor overpull is the deforming force. Accurate diagnosis and application of the proper surgical technique are essential when treating swan neck deformity in patients with cerebral palsy...
April 2014: Journal of Hand Surgery
Ettore Laracca, Caroline Stewart, Neil Postans, Andrew Roberts
Children with cerebral palsy often undergo multiple orthopaedic surgical procedures in a single episode. Evidence of the effectiveness of individual components within the overall package is sparse. The introduction of musculoskeletal modelling in Oswestry has led to a more conservative management approach being taken with hamstring muscles for children walking in a degree of crouch. Muscles which were shown to be of at least normal length at initial contact were not surgically lengthened, as would have been the case previously...
March 2014: Gait & Posture
M C M Klotz, S I Wolf, D Heitzmann, B Krautwurst, F Braatz, T Dreher
Knee hyperextension (genu recurvatum, GR) is often seen in children with bilateral spastic cerebral palsy (CP). Primary GR appears essential without previous treatment. As equinus deformity is suspected to be one of the main factors evoking primary GR, the purpose of this study was to determine whether lengthening the calf muscles to decrease equinus would decrease coexisting GR in children with bilateral spastic CP. In a retrospective study, 19 CP patients with primary GR (mean age: 9.4 years, 13 male, 6 female, 26 involved limbs) in whom an aponeurotic calf muscle lengthening procedure was performed during single-event multilevel surgery were included and investigated using three-dimensional gait analysis before and at a mean follow-up of 14 months after the procedure according to a standardized protocol...
November 2013: Research in Developmental Disabilities
Ahmad Zaheer Qureshi, Subramanya Adiga
CONTEXT: Excessive hip adductor spasticity in patients with spinal cord injury (SCI) can produce scissoring effect of the thighs which can interfere with various activities of daily living. If noninvasive measures do not produce desired results, surgical treatment may be considered. One surgical option for the management of adductor spasticity includes adductor tenotomy and selective obturator neurectomy. This procedure was performed in an individual with T11 paraplegia having severe adductor spasticity in both thighs...
January 2013: Journal of Spinal Cord Medicine
Benjamin Dagge, Gregory B Firth, Joseph E A Palamara, Norman Eizenberg, Susan Donath, H Kerr Graham
BACKGROUND: Medial hamstring lengthening is frequently used to correct contractures in neuromuscular conditions such as cerebral palsy. Surgical techniques vary considerably and little is known about the lengthening characteristics of muscle-tendon-units after surgical intervention. METHODS: A randomized trial was performed on paired cadaver medial hamstring muscle-tendon-units comparing 'High' (proximal) versus 'Low' (distal) lengthening procedures. The paired muscle-tendon-units were subjected to tensile testing utilizing an Instron® (Instron Corporation, Canton, MA, USA) machine under controlled conditions...
May 2012: ANZ Journal of Surgery
Cheng-Li Lin, Chii-Jeng Lin, Ming-Tung Huang, Wei-Ren Su, Tung-Tai Wu
Equinus of the ankle is a common deformity in spastic cerebral palsy. Many methods have been developed to lengthen the Achilles tendon to correct the deformity. A new mesh Achilles tendon lengthening (ATL) procedure that might decrease immobilization and promote recovery was performed in 36 tendons with equinus deformity (22 patients, average age=6.2). The results were compared with those of two other methods: the Vulpius group and the Z-lengthening group. The corrected dorsiflexion angle of the ankle at a subsequent 2-year follow-up of the mesh ATL and Vulpius groups matched (25...
January 2013: Journal of Pediatric Orthopedics. Part B
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