PURPOSE: The aims of the study were to evaluate the outcomes and predictive factors of the split anterior tibialis tendon transfer (SPLATT) procedure for the treatment of the spastic equinovarus deformity in children with cerebral palsy (CCP). METHODS: Forty-five ambulatory CCP with 68 equinovarus feet, positive for the flexor withdrawal reflex test, aged 8.1 ± 2.5 (range four to 15) years were enrolled. All feet underwent a soft tissue release procedure combined with the SPLATT procedure and were followed for at least 12 months after surgery. The functional outcome was rated using the criteria of Kling and co-workers. Pre-treatment gross motor functional classification system (GMFCS) levels were compared to the patients' latest evaluations. Factors associated with outcomes and success rate were assessed. RESULTS: At an average follow-up of 5.5 ± 3.3 (range 1.1-16) years, feet were rated as excellent in 48 cases (70 %), good in ten (15 %) and poor in ten (15 %), respectively. Thirty-four CCP showed an improvement for the GMFCS level, P < 0.001. The factor that could predict a poor outcome was the pre-treatment GMFCS levels 3-4 with an odds ratio (95 % CI) of 4.92 (0.96-25.2), P = 0.03. The ten years success rate of the SPLATT procedure between CCP with GMFCS levels 1-2 and levels 3-4 were not different with a mean ± SD (95 % CI) of 0.85 ± 0.1 (0.5-0.96) versus 0.6 ± 0.1 (0.3-0.8), P = 0.08, respectively. CONCLUSIONS: The SPLATT procedure provides a balanced function of the foot, thus improving the ambulatory ability in CCP and should be integrated into the surgical plan. Pre-treatment GMFCS levels 3-4 predicted unfavourable outcomes and should be addressed during pre-operative parental counselling.
PURPOSE: The aims of the study were to evaluate the outcomes and predictive factors of the split anterior tibialis tendon transfer (SPLATT) procedure for the treatment of the spastic equinovarus deformity in children with cerebral palsy (CCP). METHODS: Forty-five ambulatory CCP with 68 equinovarus feet, positive for the flexor withdrawal reflex test, aged 8.1 ± 2.5 (range four to 15) years were enrolled. All feet underwent a soft tissue release procedure combined with the SPLATT procedure and were followed for at least 12 months after surgery. The functional outcome was rated using the criteria of Kling and co-workers. Pre-treatment gross motor functional classification system (GMFCS) levels were compared to the patients' latest evaluations. Factors associated with outcomes and success rate were assessed. RESULTS: At an average follow-up of 5.5 ± 3.3 (range 1.1-16) years, feet were rated as excellent in 48 cases (70 %), good in ten (15 %) and poor in ten (15 %), respectively. Thirty-four CCP showed an improvement for the GMFCS level, P < 0.001. The factor that could predict a poor outcome was the pre-treatment GMFCS levels 3-4 with an odds ratio (95 % CI) of 4.92 (0.96-25.2), P = 0.03. The ten years success rate of the SPLATT procedure between CCP with GMFCS levels 1-2 and levels 3-4 were not different with a mean ± SD (95 % CI) of 0.85 ± 0.1 (0.5-0.96) versus 0.6 ± 0.1 (0.3-0.8), P = 0.08, respectively. CONCLUSIONS: The SPLATT procedure provides a balanced function of the foot, thus improving the ambulatory ability in CCP and should be integrated into the surgical plan. Pre-treatment GMFCS levels 3-4 predicted unfavourable outcomes and should be addressed during pre-operative parental counselling.
Authors: Tishya A L Wren; Susan A Rethlefsen; Bitte S Healy; K Patrick Do; Sandra W Dennis; Robert M Kay Journal: J Pediatr Orthop Date: 2005 Sep-Oct Impact factor: 2.324
Authors: Brett Lullo; Alexander Nazareth; Susan Rethlefsen; Kenneth D Illingworth; Oussama Abousamra; Robert M Kay Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2020-05