Retrospective case series of inverted V-shape tenotomy of gastrocnemius and recession of soleus at the musculotendinous junction for the treatment of fixed equinus deformity in children with cerebral palsy

Abstract

Background: The authors describe results of a surgical percutaneous procedure for gastrocnemius-soleus lengthening at musculotendinous junction using a one-cut inverted V-shape technique for equinus correction in patients with cerebral palsy (CP). Methods: This was a retrospective case-series study of 52 patients with spastic CP between November 2001 and November 2016. Gross Motor Function Classification System (GMFCS) levels (II-IV) were involved. Statistical analysis was carried out for ankle dorsiflexion angles with knee extended and flexed, popliteal angle, and Gillette Functional Assessment Questionnaire (FAQ). Failure was determined by recurrence of equinus deformity or developing crouch gait due to overlengthening. Results: A mean age of 7 yr was recorded, with a minimum follow-up of 1 yr. A total number of 88 feet were operated upon, including several children who had bilateral deformities. Twelve (23%) patients were operated previously by either percutaneous or open tendo-Achilles lengthening. Success was achieved in 44 patients (85%), and eight patients (15%) had failure. Noncompliance with physical therapy and night splinting were the determined causes of failure for patients who had recurrence. GMFCS level-IV was a particular risk of failure (75%). No patient developed postoperative crouch gait caused by an over-lengthened tendo-Achilles. The improvement in the outcome measures were clinically significant in the successful group. Conclusions: The authors’ percutaneous gastrocnemius-soleus lengthening one-cut technique is a safe, cosmetic, and economic day-case surgery. It has low recurrence rate, with minimal risk of developing a crouched gait from overlengthening. Level of Evidence: Level IV.