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Split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia

PURPOSE: The aim of this study is to report the safety and eff-cacy of soft-tissue surgery incorporating split transfer of tibi-alis anterior to peroneus brevis (SPLATT-PB) for children with hemiplegic spastic equinovarus. METHODS: This was a retrospective case series of children and adolescents wit...

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Autores principales: Wong, Peter, Fransch, Shaneil, Gallagher, Charles, Francis, Kate Louise, Khot, Abhay, Rutz, Erich, Graham, H. Kerr
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone & Joint Surgery 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223092/
https://www.ncbi.nlm.nih.gov/pubmed/34211605
http://dx.doi.org/10.1302/1863-2548.15.210033
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author Wong, Peter
Fransch, Shaneil
Gallagher, Charles
Francis, Kate Louise
Khot, Abhay
Rutz, Erich
Graham, H. Kerr
author_facet Wong, Peter
Fransch, Shaneil
Gallagher, Charles
Francis, Kate Louise
Khot, Abhay
Rutz, Erich
Graham, H. Kerr
author_sort Wong, Peter
collection PubMed
description PURPOSE: The aim of this study is to report the safety and eff-cacy of soft-tissue surgery incorporating split transfer of tibi-alis anterior to peroneus brevis (SPLATT-PB) for children with hemiplegic spastic equinovarus. METHODS: This was a retrospective case series of children and adolescents with spastic hemiplegia who had a novel combination of SPLATT-TB, intramuscular tenotomy of tibialis posterior and either spasticity management or gastrocsole-us lengthening as the index surgery. The principal outcome measures were changes in pain and difficulty with shoe wear and radiological parameters obtained from weight-bearing anteroposterior and lateral radiographs of the affected foot before and after surgery. RESULTS: A total of 63 patients with symptomatic spastic equinovarus met the inclusion criteria. Mean age at surgery was 9.8 years (6 to 18) and the mean follow-up was seven years (range 3 to 10 years). Foot pain and problems with shoe wear improved after surgery. Seven radiological criteria showed a clinically and statistically significant improvement at follow-up, the majority being in the normal range. There were 11 surgical adverse events, all classified as Modified Cla-vien-Dindo Grade II. Three patients required further surgery for recurrent equinus, eight patients required further surgery for valgus deformities and four patients required bony surgery for residual varus deformities. CONCLUSION: Soft-tissue surgery for spastic equinovarus was successful in the majority of children with spastic hemiplegia, particularly between ages eight and 12 years, resulting in a plantigrade, flexible foot with minimal pain or limitations in shoe-wear. Children younger than 8 years at index surgery were more prone to overcorrection into valgus. Children older than 12 years had persistent varus deformities requiring bony surgery. LEVEL OF EVIDENCE: Level IV, retrospective case series
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spelling pubmed-82230922021-06-30 Split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia Wong, Peter Fransch, Shaneil Gallagher, Charles Francis, Kate Louise Khot, Abhay Rutz, Erich Graham, H. Kerr J Child Orthop Original Clinical Article PURPOSE: The aim of this study is to report the safety and eff-cacy of soft-tissue surgery incorporating split transfer of tibi-alis anterior to peroneus brevis (SPLATT-PB) for children with hemiplegic spastic equinovarus. METHODS: This was a retrospective case series of children and adolescents with spastic hemiplegia who had a novel combination of SPLATT-TB, intramuscular tenotomy of tibialis posterior and either spasticity management or gastrocsole-us lengthening as the index surgery. The principal outcome measures were changes in pain and difficulty with shoe wear and radiological parameters obtained from weight-bearing anteroposterior and lateral radiographs of the affected foot before and after surgery. RESULTS: A total of 63 patients with symptomatic spastic equinovarus met the inclusion criteria. Mean age at surgery was 9.8 years (6 to 18) and the mean follow-up was seven years (range 3 to 10 years). Foot pain and problems with shoe wear improved after surgery. Seven radiological criteria showed a clinically and statistically significant improvement at follow-up, the majority being in the normal range. There were 11 surgical adverse events, all classified as Modified Cla-vien-Dindo Grade II. Three patients required further surgery for recurrent equinus, eight patients required further surgery for valgus deformities and four patients required bony surgery for residual varus deformities. CONCLUSION: Soft-tissue surgery for spastic equinovarus was successful in the majority of children with spastic hemiplegia, particularly between ages eight and 12 years, resulting in a plantigrade, flexible foot with minimal pain or limitations in shoe-wear. Children younger than 8 years at index surgery were more prone to overcorrection into valgus. Children older than 12 years had persistent varus deformities requiring bony surgery. LEVEL OF EVIDENCE: Level IV, retrospective case series The British Editorial Society of Bone & Joint Surgery 2021-06-01 /pmc/articles/PMC8223092/ /pubmed/34211605 http://dx.doi.org/10.1302/1863-2548.15.210033 Text en Copyright © 2021, The author(s) https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Original Clinical Article
Wong, Peter
Fransch, Shaneil
Gallagher, Charles
Francis, Kate Louise
Khot, Abhay
Rutz, Erich
Graham, H. Kerr
Split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia
title Split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia
title_full Split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia
title_fullStr Split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia
title_full_unstemmed Split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia
title_short Split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia
title_sort split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223092/
https://www.ncbi.nlm.nih.gov/pubmed/34211605
http://dx.doi.org/10.1302/1863-2548.15.210033
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