Abstract
Aim: The aim of this study was to evaluate the surgical outcome, in terms of gait improvement, of endoscopic transverse Vulpius gastrocsoleus recession in children with cerebral palsy compared to the traditional open surgery.Methods: Twenty-seven children with cerebral palsy who had undergone endoscopic transverse Vulpius gastrocsoleus recession were reviewed. For the comparison of gait improvement, independent ambulatory spastic diplegic patients who had undergone only endoscopic transverse Vulpius gastrocsoleus recession on both legs were selected. Seven (14 legs) children were included and the median age was 7 years (6–9 years). Seven age-matched patients with the same inclusion/exclusion criteria who underwent open surgery were selected as the control group. Physical examination and gait parameters were evaluated and compared between groups, including the gait deviation index (GDI), and gait profile score (GPS).Results: There was no significant complication in twenty-seven children after endoscopic transverse Vulpius gastrocsoleus recession. However, one patient required a revision open surgery at postoperative 1 year 9 months due to the recurrence of equinus and the incomplete division of the midline raphe which was noted during surgery. When comparing gait improvements, there were no differences between the endoscopic and open surgery groups in ankle dorsiflexion angle, ankle kinetics, GDI, and GPS. The postoperative peak ankle dorsiflexion during stance phase was slightly higher in the open group.Conclusion: This is the first study that evaluates gait improvement exclusively for children with spastic diplegia after endoscopic transverse Vulpius gastrocsoleus recession. The gait improvements after endoscopic surgery were comparable to the open surgery, however, the possibility of reduced improvement in ankle kinematics should be considered.
Highlights
For the correction of ankle equinus, there are several surgical methods, such as lengthening of the Achilles tendon, gastrocsoleus recession, and intramuscular lengthening of gastrocnemius or soleus
The control group consisted of patients who had undergone open transverse Vulpius gastrocsoleus recession and met the same inclusion and exclusion criteria
There was no significant loss of ankle plantarflexion which demonstrated over-correction or crouch gait at final follow-up
Summary
For the correction of ankle equinus, there are several surgical methods, such as lengthening of the Achilles tendon, gastrocsoleus recession, and intramuscular lengthening of gastrocnemius or soleus. Surgical outcome of endoscopic gastrocnemius recession has been reported as safe with minimal incision scarring [2,3,4,5,6]. Grady et al reported an acceptable outcome of endoscopic gastrocsoleus recession in children, but all the patients were neurologically healthy [3]. An optimal gastrocsoleus recession is critical because of the risk of crouch gait from overcorrection, or the possibility of reoperation after the recurrence of equinus because of under correction in patients with cerebral palsy [8,9,10,11]
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