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>Journals >Revista Mexicana de Ortopedia Pediátrica >Year 2018, Issue 2


Rocha GA, López VA, Hutchinson B, Southerland C, Kashuk K, Hatch D, Dockery D, Sosa CJ, Esperón HR
Heel cord advancement vs Achilles fractional lengthening to correct neurospastic foot equinus in children, retrospective analysis
Rev Mex Ortop Ped 2018; 20 (2)

Language: Espańol
References: 18
Page: 72-79
PDF: 197.74 Kb.

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ABSTRACT

Introduction: Neurospastic ankle equinus is one of the most common and disabling condition in children with cerebral palsy. A 10° deformity in plantar flexion of the ankle is enough to disturb the gait and the limb biomechanics. Several techniques for correction are reported; two of them achilles advancement (Murphy technique) and Achilles fractional lengthening with controversial results on the literature. The objective of this study was to evaluate functional results on our Institution with these two techniques applied on two uniform groups to correct neurospastic equinus. Methods: Retrospective analysis of functional results for correction of neurospastic equinus with Achilles advancement (Murphy) or Achilles Fractional Lengthening (TAL) of surgeries performed from 1998 to 2012 at our Institution, using Functional Mobility Score (FMS), Physician Rating Scale PRS and Edimburgo visual gait analysis. Results were compared using t Student and we also performed a cost benefit analysis considering the success and the relapse rates. Results: Twenty-five patients were includes (12 feet with Murphy and 13 with TAL). Murphy group 7.55 years mean age, mean difference for dorsiflexion 43°, FMS preop. 8.25 pts, postop. 14.75 pts. Edimburgo preop. 38.3 pts, postop. 26.91 pts; 91.7% success rate and one relapse (8.3%) TAL group 6.69 years mean age, mean difference for dorsiflexion 31°, FMS preop. 9.38 pts, postop. 14.53 pts. Edimburgo preop. 40.46 pts., postop. 11.38 pts., 38.3% success rate, and two relapses (15.38%) and three Achilles insufficiencies (23.07%), Murphy patients stopped using orthoses and had no insufficiencies, performing better cost-benefit. Discussion: Murphy and Pierrot reported 81% success with HCA, at our Institution it was higher, and we also had no patients using orthoses after surgery. Borton and colleagues studied 195 procedures in 134 children with neurospastic equinus corrected by TAL, they found 58% of Achilles insufficiency which determined a calcaneovalgus and crouch gait in these children. We found the biomechanic explanation of our results in Southerland’s paper,9 which states that HCA does not changes the architecture of Achilles, but enhaces it’s lever arm by modifying the insertion place. Conclusions: Heel cord advancement with modified Murphy technique reported better results, less relapse and complications than percutaneous Achilles tendon lengthening to correct neurospastic foot equinus in children at our Institution.


Key words: Achilles cord advancement, neurospastic equinus, Achilles fractional lengthening, surgical correction, cerebral palsy, children, cost-benefit.





>Journals >Revista Mexicana de Ortopedia Pediátrica >Year 2018, Issue 2
 
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