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Tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy

Rutz, E; Baker, RJ; Tirosh, O; Romkes, J; Haase, C; Brunner, R

Authors

E Rutz

RJ Baker

O Tirosh

J Romkes

C Haase

R Brunner



Abstract

Equinus is the commonest deformity in cerebral palsy (CP). Many different surgical procedures have been
described for the treatment of spastic equinus. In long standing equinus deformities the tibialis anterior
muscle becomes elongated which is one reason for muscle weakness. Surgical tendon shortening of the
tibialis anterior tendon was therefore introduced to rebalance muscle strength.
All patients with CP who had a tibialis anterior tendon shortening (TATS) in combination with a tendo
Achilles lengthening (TAL) were included in this study. A total of 29 patients had 30 surgical interventions
(21 hemiplegic patients: 14 boys/7 girls, age 9–22 years; mean 15.2 years; 5 diplegics and 3
quadriplegics; 5 boys/3 girls, age 7–37.5 years; mean 14.8 years). Fifteen patients had additional surgery
(soft tissue or bony procedures). The TATS was performed at the distal insertion with transosseous
tendon fixation in the medial cuneiform bone at the original place.
Movement Analysis Profile (MAP) for ankle dorsi-/plantarflexion, Gait Profile Score (GPS), Gait
Deviation Index (GDI), and Gillette Gait Index (GGI) improved significantly for all patients compared preto
postoperatively. In 93% of the patients active dorsiflexion of the ankle was possible postoperatively.
We conclude that TATS in combination with TAL in spastic equinus in CP is a safe procedure and
improves but not completely corrects foot positioning during gait. For the treatment of spastic equinus in
CP we recommend shortening of the elongated antagonist (TATS) in combination with lengthening of the
short agonist (TAL) for achieving optimal postoperative function.

Citation

Rutz, E., Baker, R., Tirosh, O., Romkes, J., Haase, C., & Brunner, R. (2011). Tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy. Gait & Posture, 33(2), 152-157. https://doi.org/10.1016/j.gaitpost.2010.11.002

Journal Article Type Article
Publication Date Feb 1, 2011
Deposit Date Oct 3, 2011
Journal Gait & Posture
Print ISSN 0966-6362
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 33
Issue 2
Pages 152-157
DOI https://doi.org/10.1016/j.gaitpost.2010.11.002
Keywords Cerebral palsy, spastic equinus, outcome, surgical correction
Publisher URL http://dx.doi.org/10.1016/j.gaitpost.2010.11.002



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