title: Recurrence of equinus foot deformity after tendo-achilles lengthening in patients with cerebral palsy.
abstract: BACKGROUND
  Recurrence of equinus deformity after surgery is common in patients with cerebral palsy. This retrospective study was undertaken to estimate the recurrence rate of the equinus deformity after tendo-Achilles lengthening (TAL) in patients with cerebral palsy and to investigate the risk factors associated with the recurrence.
  
  
  METHODS
  Two-hundred forty three ambulatory patients with cerebral palsy, who underwent TAL for equinus foot deformity since 1995, and had undergone a preoperative and postoperative 3-dimensional gait analysis, were included. Cox proportional hazards model was used to determine the significant contributing factor for the recurrence of equinus foot deformity.
  
  
  RESULTS
  The mean patient age at surgery was 7.8±2.7 years and the mean follow-up duration was 8.1±3.4 years. Equinus deformity recurred in 22 of the 243 patients (9.1%) and the Kaplan-Meier survival estimate was shown to be 89.4% at 10 years not needing repeat surgery. According to the multivariate analysis using the Cox proportional hazard model, preoperative ankle dorsiflexion at initial contact (P=0.016) was the only significant factor for recurrence of equinus deformity after surgery. Age at surgery and the type of limb involvement were not associated with the recurrence (P=0.433 and 0.269). The cutoff values of preoperative gait kinematics between the nonrecurrence and recurrence groups were -19 degrees of ankle dorsiflexion at initial contact (P=0.018).
  
  
  CONCLUSIONS
  This study showed that the severity of preoperative equinus deformity was a risk factor associated with recurrence after TAL in patients with cerebral palsy. Therefore, surgeons should consider the recurrence and later revision surgery for the patients with severe equinus foot deformity.
  
  
  METHODS
  Therapeutic level III.
authors: *Department of Orthopaedic Surgery, Seoul National University Bundang Hospital †Department of Orthopaedic Surgery, Myongji Hospital, Kyungki ‡Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul, Korea.
authors: Chin Youb
authors: CY
authors: Chung
authors: Ki Hyuk
authors: KH
authors: Sung
authors: Kyoung Min
authors: KM
authors: Lee
authors: Seung Yeol
authors: SY
authors: Lee
authors: In Ho
authors: IH
authors: Choi
authors: Tae-Joon
authors: TJ
authors: Cho
authors: Won Joon
authors: WJ
authors: Yoo
authors: Moon Seok
authors: MS
authors: Park
mesh_terms: D000125:Achilles Tendon / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004863:Equinus Deformity / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D058971:Tenotomy / Q000009:adverse effects / Q000379:methods