Benefits of Tendon Transfer Surgery in Cerebral Palsy

Abstract

Research Article| August 01 2015 Benefits of Tendon Transfer Surgery in Cerebral Palsy AAP Grand Rounds (2015) 34 (2): 17. https://doi.org/10.1542/gr.34-2-17 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Benefits of Tendon Transfer Surgery in Cerebral Palsy. AAP Grand Rounds August 2015; 34 (2): 17. https://doi.org/10.1542/gr.34-2-17 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: arm, botulinum toxins, cerebral palsy, tendon transfer procedure Source: Van Heest A, Bagley A, Molitor F, et al. Tendon transfer surgery in upper-extremity cerebral palsy is more effective than botulinum toxin injections or regular, ongoing therapy. J Bone Joint Surg. 2015; 97(7): 529– 536; doi: https://doi.org/10.2106/JBJS.M.01577Google Scholar Investigators from 7 Shriners Hospitals sought to determine the most effective treatment for upper extremity muscle contractures in children with spastic, hemiplegic cerebral palsy (CP). Patients with upper extremity CP, aged 4 to 16 years, were prospectively assigned randomly or by patient/family preference to 1 of 3 treatment groups: surgery (Group 1), botulinum toxin injections (Group 2), or regular ongoing therapy (Group 3). All 3 patient groups also received standard supervised occupational therapy (OT) followed by home therapy. Standardized validated outcome tools were used for assessment. Outcomes measurements included active range of motion, pinch and grip strength, stereognosis, and scores from 8 other functional or patient-orientated validated outcome tools including dynamic positional analysis (DPA), 5 domains in the Pediatric Quality of Life Inventory (PedsQL), and the Canadian Occupational Performance Measure (COPM-satisfaction score). Change from baseline for each of these outcomes was compared among children in the 3 treatment groups. Thirty-nine patients were enrolled in the study, 29 by randomization and 10 by patient/family preference. Thirty-four patients (25 randomized and 9 patient/family-preference) were evaluated 12 months post-treatment. This included 16 in Group 1, 9 in Group 2, and 9 in Group 3. Significantly greater improvement in DPA was seen among those in Group 1 (surgery) compared to the other 2 groups (P < .001). These changes reflected improvement in supination and wrist extension during functional activities after surgical treatment. Participants in Group 1 also showed more improvement in the PedsQL-CP module domain of movement compared to those in the other groups (P = .002). The mean increase in Group 1 was 26.4% while Group 2 and Group 3 both had a mean decrease of 3.3%. For the other 4 domains of the PedsQL-CP module – school, fatigue, eating, and speech – there were no significant differences among treatment groups. Group 1 also showed more improvement in the COPM score than Groups 2 and 3 (P = .002). Children in groups 1 and 3 showed significantly more improvement in pinch strength than those from Group 2. The authors conclude that for children with upper extremity CP, surgical treatment results in significantly greater functional improvement and satisfaction than botulinum toxin injections or regular therapy. Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. In children with hemiplegic CP, the abnormal muscle tone patterns cause the arm and hand to be positioned in elbow flexion, forearm pronation, wrist flexion, and thumb in palm. These contractures limit function. Nonsurgical and surgical treatments exist to reduce the deformities and improve function. Nonsurgical treatments include botulinum toxin injections and OT.1–3 Botulinum toxin... You do not currently have access to this content.