Outcomes of gastrocnemius-soleus complex lengthening for isolated equinus contracture in children with cerebral palsy.
BACKGROUND
The goal of the gastrocnemius-soleus complex (GSC) lengthenings in children with cerebral palsy (CP) is to achieve a plantigrade foot and normalize kinematics during gait. The study purpose was to evaluate the results of GSC lengthening for isolated equinus contracture in individuals with CP. It was hypothesized that GSC lengthenings would normalize passive ankle range of motion, kinematic, kinetic, and temporal spatial parameters.


METHODS
Gait data from 15 able-bodied participants from the laboratory normal database and passive range of motion, kinematic, kinetic, and temporal spatial gait parameters, and oxygen cost were collected and analyzed for 27 individuals with CP (36 limbs) with isolated equinus contracture who received GSC lengthenings. Data were compared between preoperative and postoperative assessments.


RESULTS
Mean age at baseline was 11.4 years (+/-3.2 y). Mean time between surgery and postoperative gait analysis was 1.3 years (+/-0.3 y). Passive range of motion measurements were obtained. Kinematic and kinetic data for the hip, knee and ankle, and temporal spatial parameters were obtained from a representative gait trial preoperatively and postoperatively. Paired t tests (P<0.05) determined whether preoperative data differed from postoperative data or from able-bodied data. The passive range of motion at the ankle was improved and normalized postoperatively. Ankle kinematics normalized without compensatory changes occurring at the knee or hip kinematics. Ankle moments and powers become more normal but did not completely normalize. Kinematics and kinetics of the hip and knee were not adversely affected. No changes in the temporal spatial data or oxygen cost occurred postoperatively.


CONCLUSIONS
These data support the finding that with appropriate patient selection isolated GSC lengthening does not result in overcorrection.


METHODS
Retrospective comparative study; level 3.
Tylkowski
Chester M
CM
Shriners Hospital for Children, and Department of Orthopedics, University of Kentucky, Chandler Medical Center, College of Medicine, Lexington, KY 40502, USA. ctylkowski@shrinenet.org
Horan
Mike
M
Oeffinger
Donna J
DJ
D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D003025:Clubfoot / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome