Norine Ma1, Nicholas Sclavos1, Elyse Passmore1,2,3, Pam Thomason1,2, Kerr Graham1,2,4, Erich Rutz1,2,4,5. 1. Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children's Hospital, Parkville, Melbourne, VIC 3052, Australia. 2. Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia. 3. Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, VIC 3052, Australia. 4. Department of Pediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia. 5. Medical Faculty, The University of Basel, 4001 Basel, Switzerland.
Abstract
Background and Objectives: Equinus is the most common deformity in children with cerebral palsy, and surgical lengthening of the gastrocsoleus muscle-tendon unit is the most commonly performed operation for children with cerebral palsy. Treatment outcomes of orthopaedic surgery can be measured objectively with three-dimensional gait analysis. This study examined the quality of evidence for gastrocsoleus lengthening surgery based on objective measures. Materials and Methods: A search was performed with Medline, Embase and PubMed from 1990 to 25 August 2020 using the keywords "cerebral palsy", "equinus", "surgery" and "gait analysis". Only studies of gastrocsoleus lengthening surgery using three-dimensional gait analysis were included, yielding 34 studies. Results: Fourteen studies reported swing phase kinematics and all studies reported a significant improvement. Rates of recurrent equinus and calcaneus were reported in 21 studies and varied widely based on follow-up period and surgical technique. Conclusions: Poor study quality and marked variability in study samples and interventions made comparison difficult. Future studies should consider prospective design, controls or comparison groups and more detailed breakdowns of outcomes by cerebral palsy subtype, sagittal gait pattern, and equinus type in order to allow more rigorous treatment recommendations to be made.
Background and Objectives: Equinus is the most common deformity in children with cerebral palsy, and surgical lengthening of the gastrocsoleus muscle-tendon unit is the most commonly performed operation for children with cerebral palsy. Treatment outcomes of orthopaedic surgery can be measured objectively with three-dimensional gait analysis. This study examined the quality of evidence for gastrocsoleus lengthening surgery based on objective measures. Materials and Methods: A search was performed with Medline, Embase and PubMed from 1990 to 25 August 2020 using the keywords "cerebral palsy", "equinus", "surgery" and "gait analysis". Only studies of gastrocsoleus lengthening surgery using three-dimensional gait analysis were included, yielding 34 studies. Results: Fourteen studies reported swing phase kinematics and all studies reported a significant improvement. Rates of recurrent equinus and calcaneus were reported in 21 studies and varied widely based on follow-up period and surgical technique. Conclusions: Poor study quality and marked variability in study samples and interventions made comparison difficult. Future studies should consider prospective design, controls or comparison groups and more detailed breakdowns of outcomes by cerebral palsy subtype, sagittal gait pattern, and equinus type in order to allow more rigorous treatment recommendations to be made.
Authors: Richard Baker; Jennifer L McGinley; Michael H Schwartz; Sarah Beynon; Adam Rozumalski; H Kerr Graham; Oren Tirosh Journal: Gait Posture Date: 2009-07-24 Impact factor: 2.840