Cerebral palsy tenotomy

Background Hip instability is a concern in pediatric cerebral palsy (CP) patients, with approximately one-third developing hip displacement. This may lead to pain, functional limitations, and decreased quality of life. Due to the progressive nature of hip displacement in CP, earlier surgical interventions may be beneficial. However, any shifts in practice to earlier surgical intervention, on a national scale, is not well described. The purpose of this study was to determine the recent trends in the surgical timing of hip interventions in children with CP...

Cerebral palsy (CP) encompasses a range of conditions that impact an individual's mobility, balance, and posture, making it the most prevalent motor impairment in children. In spastic cerebral palsy, muscle stiffness hinders walking and, if left untreated, may lead to complications such as hip dislocations or dysplasia. Adductor spasticity is a common challenge in these children, significantly impeding mobility and daily activities. The risk of hip dislocation escalates as gross motor function declines, particularly in children with severe impairments...

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation...

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation...

BACKGROUND: Despite being a common procedure, there are no standard protocols for postoperative immobilization and rehabilitation following reconstructive hip surgery in children with cerebral palsy (CP). The purpose of this study was to investigate variability in postoperative management and physical therapy (PT) recommendations among orthopaedic surgeons treating hip displacement in children with CP. METHODS: An invitation to participate in an anonymous, online survey was sent to 44 pediatric orthopaedic surgeons...

PURPOSE: The effects of abducted standing on hip migration percentage (MP) and range of hip and knee motion in children with cerebral palsy were studied for more than 7 years in 2 case-control groups. One group had adductor-psoas tenotomy and the other did not. METHODS: Case participants performed 15° to 30° of abduction per hip. Controls performed 0° to 10° of abduction and were matched on age, surgery, and follow-up time. RESULTS: Median MP decreased 7...

Although the correction of knee flexion by lengthening the hamstring musculature is traditionally contemplated in cerebral palsy, literature suggests that treatment of hip flexion also improves knee extension. The aim of the study was to first show the efficacy of the sequence of intrapelvic tenotomy of the psoas followed by intramuscular lengthening of the proximal rectus anterior and, later, that of both surgical soft tissue surgeries separately. For this, a prospective study was carried out in 10 patients with a mean age of 14 years, which presented 16 fixed knee flexes with a mean of deformity of 22°...

BACKGROUND: Orthopedic surgery in children with cerebral palsy (CP) aims to improve function and prevent deformities. Each child's condition in CP is unique and many co-variables influence surgical decision-making including a patient's age and their functional level. Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels, particularly in countries from Latin America. AIM: To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP...

Background and purpose - Children with cerebral palsy (CP) have an increased risk of hip dislocation. Outcome studies after surgery to prevent hip dislocation in children with CP are usually retrospective series from single tertiary referral centers. According to the national CP surveillance program in Sweden (CPUP), hip surgery should preferably be performed at an early age to prevent hip dislocation. Preventive operations are performed in 12 different Swedish hospitals. We compared the outcomes between soft tissue release and femoral osteotomy in children with CP treated in these hospitals...

Objective: Postoperative management of children having cerebral palsy (CP) with mental retardation is difficult. This report presents a case of severe CP with mental retardation, which resulted in anorexia and condylar fracture of the femur following a surgery for bilateral lower limb joint contracture. Case report: A 14-year-old male was diagnosed with CP having severity of Gross Motor Functional Classification System Level V, and severe mental retardation. Due to bilateral spasticity in hip adduction, knee flexion, and valgus of the feet, tenotomies of the adductors of both hips, bilateral lengthening of the hamstrings and bilateral tenotomy of the peroneal tendons were performed...

PURPOSE: Progressive hip displacement is one of the most common orthopaedic pathologies in children with cerebral palsy (CP). Reconstructive hip surgery has become the standard treatment of care. Reported avascular necrosis (AVN) rates for hip reconstructive surgery in these patients vary widely in the literature. The purpose of this study is to identify the frequency and associated risk factors of AVN for reconstructive hip procedures. METHODS: A retrospective analysis was performed of 70 cases of reconstructive hip surgery in 47 children with CP, between 2009 and 2013...

Background and purpose - Hip displacement is frequent in nonambulatory children with cerebral palsy (CP) and treatment is controversial. This prospective study assesses the effectiveness of soft-tissue releases to treat hip subluxation, analyses prognostic factors for outcome, and identifies time to failure in hips with poor outcome. Patients and methods - 37 children (16 girls) with hip subluxation were recruited from the population-based screening program for children with CP in Norway. They had consecutively undergone soft-tissue releases (bilateral tenotomies of adductors and iliopsoas) at a mean age of 5...

BACKGROUND: Spastic thumb deformity in cerebral palsy significantly impedes hand function. Flexion-adduction forces across the first ray is the result from imbalance between intrinsic and extrinsic muscles. Multiples surgeries have been devised for the treatment of this condition such as contracture release and by tendon transfers for balancing the muscles forces. We report the results of a less demanding surgical technique, intended to avoid hyperextension of the metacarpophalangeal joint previously described in other series...

Clubfoot is one of the most common congenital orthopaedic anomalies and was described by Hippocrates in the year 400 BC. From manipulation in antiquity to splint and plaster in the Renaissance the treatment had improved before tenotomy. Tenotomy was tested during the 19th century and will be explained in this manuscript; the introduction of subcutaneous tenotomy of the Achilles tendon had focused the attention of surgeons on the surgical treatment of clubfeet. While this operation was very successful in the correction of equinus deformities due to poliomyelitis, cerebral palsy, and old injuries, it was not a panacea for the patient with the congenital clubfoot...

Background and purpose - Studies have indicated that one-third of children with cerebral palsy (CP) develop dislocation of the hip that needs surgical intervention. When hip dislocation occurs during childhood surgical treatment consists of tenotomies, femoral varus derotation osteotomy (VDRO), and acetabuloplasty. Relapse is observed in one-fifth of cases during adolescence. In this prospective cohort study, we performed a descriptive evaluation of translation and rotation across VDROs in children with neuromuscular disorders and syndromes by radiostereometric analysis (RSA)...

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...

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...

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...

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...

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...