Soft Tissue Lengthening Research Articles

Effect of maxillary distraction osteogenesis and LeFort-1 advancement orthognathic surgery on soft-tissue thickness and anterior soft-tissue to hard-tissue movement ratios among patients with complete unilateral cleft lip and palate

Objectives: The objective of this study was to compare the soft-tissue thickness and anterior soft-tissue to hard-tissue movement ratios in patients with unilateral cleft lip and/or palate (UCLP) following maxillary distraction osteogenesis using rigid external distractor device and maxillary advancement at LeFort I level using lateral cephalograms. Material and Methods: This retrospective study was conducted on 20 patients with UCLP who underwent either LeFort I maxillary advancement or maxillary distraction osteogenesis. Non-syndromic patients with complete UCLP anomalies and skeletal class III patterns due to maxillary hypoplasia were included in the study. The patients with a pre-surgical negative overjet of ≥5 mm were treated by maxillary distraction osteogenesis, while a negative overjet of <5 mm was managed with maxillary advancement orthognathic surgery. The growth completion in all the patients was assessed using the cervical vertebrae maturation index (CS 6) on a lateral cephalogram. The lateral cephalograms taken before surgery at (T0) and after a minimum interval of six months (T1) of surgery were assessed for changes in soft-tissue thickness and hard-tissue to soft-tissue movement ratios among the two groups. Paired t-test was used to compare the mean values obtained within the same group at two different time intervals. Unpaired t-test was used to compare mean values between the Groups 1 and 2. Pearson’s correlation coefficient (r) test was used to assess the associations between the mean changes in hard- and soft-tissue variables. Results: Group 1 showed significantly greater maxillary advancement compared to Group 2 with a mean difference of 5.80 mm at Point A and 7.65 mm at the upper incisal edge. Soft-tissue thickness decreased significantly after advancement in Group 1 at subnasale (P < 0.05), labrale superius, stomion, and labrale inferius (P < 0.01) and at subnasale (P < 0.05), stomion and labrale inferius (P < 0.01) in Group 2. There was a significantly strong correlation between the hard- and soft-tissue movement in sagittal plane in both Group 1 and Group 2. In Groups 1 and 2, a statistical highly significant strong positive correlation was found between vertical change in dU1 to soft-tissue dLs and dStms. In Group 2, a statistical highly significant strong positive correlation was found between vertical change in dA to soft-tissue dC and dStms. Conclusion: The soft-tissue thickness reduced in patients with UCLP after maxillary advancement in both groups. The soft tissue followed the hard tissue in both groups. There was a greater downward movement of the maxillary base and soft-tissue lengthening in Group 1 compared to Group 2.

Hip displacement in children with cerebral palsy: surveillance to surgery - a current concepts review.

This review brings together a multidisciplinary, multinational team of experts to discuss the current state of knowledge in the detection and treatment of hip displacement in cerebral palsy (CP), a global public health problem with a high disease burden. Though common themes are pervasive, different views are also represented, reflecting the confluence of traditional thinking regarding the aetiology and treatment of hip displacement in CP with emerging research that challenges these tried-and-true principles. The development of hip displacement is most closely related to gross motor function, with radiographic surveillance programs based on the Gross Motor Function Classification System (GMFCS), the goal being early detection and timely treatment. These treatments may include non-operative methods such as abduction bracing and Botulinum Neurotoxin A (BoNT-A), but outcomes research in this area has been variable in quality. This has contributed to conflicting opinions and limited consensus. Soft tissue lengthening of the hip adductors and flexors has traditionally been employed for younger patients, but population-based studies have shown decreased survivorship for this treatment when performed in isolation. Concerns with the identification of hip displacement in very young children are raised, noting that early reconstructive surgery has a high recurrence rate. This has prompted consideration of viable minimally invasive alternatives that may have better success rates in very young children with CP, or may at least delay the need for osteotomies. Recent reports have implicated the role of abnormal proximal femoral growth and secondary acetabular dysplasia as a primary cause of hip displacement, related to ambulatory status and abductor function. As such, guided growth of the proximal femur has emerged as a possible treatment that addresses this purported aetiology, with promising early results.

Achieving Correct Balance in Total Knee Arthroplasty with Fixed Varus Deformity.

Varus knee deformity is one of the most common deformities presenting for total knee arthroplasty (TKA). When present, a varus knee deformity contributes to overload of the medial joint compartment during gait, leading to increased medial compartment forces as well as lateral soft tissue lengthening. Additionally, a fixed varus deformity is associated with medial soft tissue contractures of the deep and superficial medial collateral ligament (MCL) and posteromedial capsule. With a fixed varus deformity, soft tissue releases may be necessary to create equivalent and rectangular flexion and extension gaps. There may also be anteromedial tibial bone defects, medial femoral condyle defects, and occasionally flexion contractures, especially in more severe cases. In cases of severe varus deformity with medial tibial bone loss, bone defects must be addressed to ensure adequate implant support. In many cases, a primary knee implant can be utilized in cases of varus knee deformity, but occasionally prostheses with higher levels of constraint may be required to balance and stabilize the knee. TKA has had a successful track record, with high levels of long-term implant survivorship even in cases of severe varus. Iatrogenic MCL instability and tibial aseptic loosening are complications associated with TKA in cases of severe varus, and multiple methods to avoid complications are presented here.

Soft Tissue Lengthening for Flexion Dislocation of Patella.

Obligatory dislocation of the patella (also known as habitual dislocation) is a rare subset of patellofemoral instability in which the patella dislocates every time the knee is flexed. The problem arises due to contracture of the quadriceps muscles. Soft tissue lengthening procedures such as quadriceps tendon lengthening are the mainstay of treatment, in contrast to medial patellofemoral reconstruction (MPFL-R) for the more common recurrent lateral patellar dislocation. The current review explores the existing literature surrounding the pathophysiology and treatment strategies for this unique cause of knee instability. Flexion dislocation of the knee often presents in children when they begin to walk. It is also termed obligatory or habitual because the patella dislocates laterally with each flexion and extension cycle of the knee. In contrast to other forms of patellar dislocation, the displacement is painless in obligatory dislocation. Likewise, the underlying biomechanical cause of this issue is related to contracture of tissues lateral to the patella rather than disruption of medial soft tissues as seen in recurrent/traumatic dislocation or subluxation of the patella. A number of procedures have been described for management of obligatory dislocation of the patella, with the general consensus that a combination of procedures including release/lengthening of the proximal lateral soft tissues as a critical component for a successful outcome. Soft tissue release/lengthening has been performed for over 50years to treat obligatory dislocation of the patella. This procedure must be used in combination with other proximal and distal reconstructive with careful intraoperative assessment of knee flexion and patellar tracking for satisfactory outcomes. Further research using standardized outcome measures is needed to identify the optimal step-wise approach in treatment of obligatory patellar dislocation.

Short-Term Outcome of Rehabilitation Program with Hybrid Assistive Limb after Tendon Lengthening in Patients with Cerebral Palsy.

In this study, we aimed to evaluate the short-term outcomes of a rehabilitation program with the Hybrid Assistive Limb® after soft tissue lengthening in young patients with cerebral palsy. We assessed six patients with cerebral palsy who underwent soft tissue surgery followed by gait training using the Hybrid Assistive Limb®. Clinical assessments were conducted preoperatively, before, immediately after, and at 1, 2, and 3 months after gait training. Gross Motor Function Measure was improved 5.93 ± 6.11% (mean ± standard deviation, p < 0.05), Canadian Occupational Performance Measure performance was improved 3.12 ± 1.53 points, and satisfaction was improved 3.80 ± 2.14 points (p < 0.05). The knee extension strength on the operated side was changed 7.75 ± 4.97 Nm after the intervention (p = 0.07). In ambulatory patients, gait speed was changed 8.37 ± 1.72 m/min, stride length was changed 10 ± 6.16 cm, and 6 min walking distance was changed 52 ± 16 m after the intervention. Training with the Hybrid Assistive Limb® may improve walking ability and clinical outcomes in young patients with cerebral palsy after soft tissue lengthening.

Pterygium Popliteal Syndrome Concerning a Case in the Pediatric Surgery Department of the Donka National Hospital (Conakry CHU)

Introduction: Popliteal pterygium syndrome is a rare birth defect, combining craniofacial, genitourinary and musculoskeletal abnormalities. It is an autosomal dominant disease caused by a mutation in the IRF6 gene. We report in this observation the 1st Guinean case corrected by the surgical method as well as a review of the literature for a diagnostic and therapeutic approach. Patient and observation: We present the case of a 7-day old male newborn weighing 2700 g who was received for bilateral cleft lip and palate, lower lip fossa or sinuses, bilateral popliteal pterygium, and triangular skin fold above the hallux. The patient underwent several surgical procedures aimed at correcting these abnormalities. The correction of the pterygium of the lower limbs was ensured by excision of the fibrous band, the tenoplasty in z of the calcaneal tendon on the right side and the skin plasty in z in series then immobilized by plaster splints. The immediate postoperative follow-up was straightforward. Conclusion: Popliteal pterygium syndrome is a rare congenital malformation, the diagnosis is primarily clinical. Early soft tissue lengthening surgery and serial z-skin plasty provide better correction of the knee pterygium. Correct correction of facial abnormalities gives the child a better appearance. The management of this syndrome is multidisciplinary.

Femoro-pedal distraction in staged reconstructive treatment of tibial aplasia.

The treatment of tibial aplasia is controversial. Amputation represents the gold standard with good functional results, but is frequently refused by the families. In these patients, treatment with reconstructive limb salvage can be considered. Due to the complexity of the deformity, this remains challenging and should be staged. The present study evaluated the role of femoro-pedal distraction using a circular external fixator in reconstructive treatment of tibial aplasia. The purpose of femoro-pedal distraction is to realign the limb and achieve soft tissue lengthening to allow subsequent reconstructive surgery. This was a retrospective study involving ten patients (12 limbs) with tibial aplasia, who underwent staged reconstruction. During the first operation a circular hexapod external fixator was applied and femoro-pedal distraction was undertaken over several months. Subsequent surgery included reconstruction of the knee joint and alignment of the foot. The mean follow-up was 7.1 years (2 to 10). The mean age of the patients at the time of the application of the fixator was 2.3 years (1.1 to 5.0). The mean time under distraction was 139.7 days (81.0 to 177.0). A mean fibular distalization of 38.7 mm (14.0 to 67.0) was achieved. Pin infections occurred in four limbs (33.3%) and osteitis in one. A femoral fracture occurred in one patient. Premature removal of the frame was not required in any patient. Sufficient realignment of the leg as well as soft tissue lengthening was achieved in all patients, allowing subsequent reconstruction. All patients were able to mobilize fully weight bearing after reconstruction. Functional outcome was limited in all limbs, and five patients (50.0%) required additional reconstructive operations. Regarding the functional results in the treatment of tibial aplasia, amputation remains superior to limb salvage. The latter procedure should only be performed in patients whose parents refuse amputation. Femoro-pedal distraction efficiently prepares the limb by realigning the leg and soft tissue lengthening. Minor complications are frequent, but usually do not hinder the continuation of distraction. Even though a fully weight-bearing limb is achieved, the functional outcome of reconstructive treatment remains limited. Recurrent deformities frequently occur and may require further operations. Cite this article: Bone Joint J 2020;102-B(9):1248-1255.

Migration percentage and odds of recurrence/subsequent surgery after treatment for hip subluxation in pediatric cerebral palsy: a meta-analysis and systematic review.

PurposeThis meta-analysis aims to systematically assess and quantitatively pool the best clinical evidence for migration percentage (MP) and odds ratio (OR) for recurrence/reoperation following treatment for hip subluxation in children with cerebral palsy (CP), including Botulinum Toxin A (BNT-A), soft-tissue lengthening and osteotomiesMethodsPubmed, EMBASE and Cochrane were systematically searched from between 1 January 1953 and 11 January 2017 inclusive for studies reporting resubluxation/reoperation rates, and/or MP following treatment for hip subluxation in children with CP. The primary outcome was odds of resubluxation/reoperation. The secondary outcome was change in MP. Studies were graded for quality using the Newcastle Ottawa Scale. This meta-analysis was performed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsA total of 14 studies were included in analysis of odds of resubluxation/reoperation and 24 studies were included in analysis of MP. The OR for resubluxation/reoperation was lower for combined osteotomies compared with femoral (OR = 0.49; 95% confidence interval (CI) 0.25 to 0.98) and for femoral osteotomy compared to soft-tissue procedures (OR = 0.20; 95% CI 0.07 to 0.61). There was no difference in odds of recurrence/reoperation between pelvic and femoral osteotomies (OR = 2.27; 95% CI 0.37 to 13.88). Combined osteotomies provided the greatest improvement in MP, while BoNT-A showed no improvement in MP.ConclusionResubluxation/reoperation rates are high; management with osteotomies is preferred to soft-tissue procedures alone in preventing resubluxation/reoperation. This meta-analysis is limited by the observational nature and small sample sizes of many of the included studies, with their inherent risk of bias and lack of homogeneity of patient characteristics at baseline. It is possible that with larger and higher quality studies, the results and conclusions of this analysis may be altered.

Preferred options and evidence for upper limb surgery for spasticity in cerebral palsy, stroke, and brain injury.

Surgical interventions for the spastic upper extremity secondary to stroke, traumatic brain injury, and cerebral palsy aim to correct the common deformities of elbow flexion, forearm pronation, wrist and finger flexion, ulnar deviation, and thumb-in-palm deformity. After appropriate evaluation, as well as determining the goals of surgery, deformity correction can be achieved through single-event, multi-level surgery. Surgery includes a combination of soft tissue lengthening, tendon transfer, and joint stabilization procedures. Surgical treatment for shoulder adduction/internal rotation, elbow flexion, forearm pronation, wrist flexion, thumb-in-palm, and clenched fist deformities due to spasticity are discussed, and treatment outcomes are reviewed.

Total Ankle Arthroplasty: Is Ankle Plantarflexion Strength Important?

Category:Ankle ArthritisIntroduction/Purpose:Ankle push off power, which requires gastroc-soleus muscle strength, is a critical aspect of healthy gait and increases as gait speed increases. It is therefore surprising that one-to-two-year outcomes following total ankle arthroplasty (TAA) include improved gait speed but deficient ankle power. One possible explanation for low ankle power following TAA is ankle plantarflexion weakness. Information on plantarflexion strength is extremely limited in people before or after TAA. Evaluating plantarflexion strength may inform postoperative expectations and guide rehabilitation programs. The purpose of this study was to evaluate the change in ankle plantarflexion strength, ankle power during gait, and gait speed before and after TAA in people with end-stage ankle arthritis, and in comparison to a healthy matched control group.Methods:Twenty-five participants were included in this prospective case-control study. TAA group participants (n = 13) [mean (SD): Age 60.9 (15.3) years; BMI 30.53 (5.5) Kg/m2; 85% male] with end-stage ankle arthritis who received a TAA were evaluated preoperatively and six months postoperatively. Performance of adjunct soft tissue procedures were patient specific (5/13 participants received tendo-achilles lengthening). All patients received formal physical therapy. Healthy control participants (n=12) were matched to the TAA group on age, gender and BMI. Ankle peak isokinetic plantarflexion strength (torque at 60 and 120 degrees/second; Nm/kg) was measured with an instrumented dynamometer. Peak ankle power (joint torque x segmental velocity; W/kg) was calculated via three-dimensional multi-segment foot motion analysis while participants walked barefoot over a force plate at controlled speeds. Gait speed (m/s) was measured with the Six-Minute Walk Test. Appropriate nonparametric comparisons were made to evaluate differences across time, between limbs, and between groups.Results:Compared to preoperative values, involved limb ankle strength was preserved at 60 and 120 degrees/second following TAA (both p > 0.59). Postoperative involved limb ankle strength at both speeds were 37-56% lower than the non-involved limb and control group (all p < 0.05) (Figure 1). Similarly, involved limb ankle power was preserved following TAA (p = 0.43), but remained at least 38% lower than the non-involved limb or control group (both p < .01). A subset analysis revealed that TAA participants with tendo-achilles lengthening had 25-33% less involved limb postoperative ankle power and strength than TAA participants without tendo-achilles lengthening. Interestingly, gait speed increased following TAA (p = 0.01) and was similar to control group speeds [TAA 1.5 vs. Control 1.6 m/s; p = 0.59].Conclusion:Robust improvements in gait speed were observed following TAA. These values approached normative gait speed in spite of diminished ankle strength and power. Ankle plantarflexion weakness reduces the capacity to generate ankle power during gait, regardless of possible contributing factors (i.e. preexisting atrophy/weakness, tendo-achilles lengthening). Accordingly, improvements in gait speed were likely linked to proximal joint compensations (i.e. hip, knee). The long term consequences of plantarflexion weakness may negatively affect implant loading. Study findings provide new information and point to the importance of targeting strength during postoperative TAA rehabilitation, potentially adjusting strategies for patients receiving soft tissue lengthening procedures.

Effects of Soft Tissue Lengthening on Gait in Children With Spasticity

Effects of Soft Tissue Lengthening on Gait in Children With Spasticity

Changes in rotational kinematics during gait in children with hemiplegic cerebral palsy following bony realignment or soft tissue lengthening

Changes in rotational kinematics during gait in children with hemiplegic cerebral palsy following bony realignment or soft tissue lengthening

Hip problems in cerebral palsy

Spastic type is the most common form of cerebral palsy. The purpose of this review was to evaluate recent literature for current trends in the surveillance and treatment of spastic hip problems in cerebral palsy. Cerebral palsy is still the most common physical disability in childhood in developed countries. Surveillance programs have had promising results in the detection of 'at risk' patients. However, neither regular radiographic screening nor surgical treatment indications and procedures have shown any progression in the last decade. In addition, recent studies have focused heavily on nonoperative treatment strategies to improve gait. Cerebral palsy is a static encephalopathy causing myostatic contractures especially in the knee and hip. Unbalanced hip contractures can lead to silent hip dislocation. Surgical and rehabilitative approaches such as soft tissue lengthening and proximal femoral and pelvic osteotomies can help patients maintain function and comfort. Selective dorsal rhizotomy or Intrathecal Baclofen Pump insertion or, recently, noninvasive techniques such as neurodevelopmental therapy may help patients and caregivers cope with what is still a devastating and inexorably progressive disorder.

Long-Term Results Following Surgical Treatment of Elbow Deformity in Patients With Cerebral Palsy

To evaluate the long-term results of surgical intervention for elbow flexion deformity in cerebral palsy. We hypothesized that improvements in elbow extension and flexion posture angle at ambulation would be maintained over time with preservation of active flexion. A total of 23 patients (23 elbows) were available for long-term follow-up. Patients had fixed elbow contractures less than 45° and were treated with partial elbow muscle lengthening. Active and passive range of motion and elbow flexion posture during ambulation were measured at each follow-up, and longitudinal results were compared. Active extension and flexion posture angle during ambulation improved 12° and 63°, respectively, with an 8° loss of active flexion. Soft tissue lengthening of the anterior elbow can provide statistically significant lasting improvements in active extension and flexion posture during ambulation in patients with cerebral palsy. Our long-term findings substantiate previously reported short-term results. Therapeutic IV.

Surgical management of long bone pseudarthrosis with severe limb length discrepancy in osteogenesis imperfecta

We report a three-stage approach in managing an 18-year-old boy with osteogenesis imperfecta who had pseudarthrosis of the left femur with 150° anterior angulation and 9.5 cm shortening. Severe long bone deformity and pseudarthrosis in osteogenesis imperfecta are difficult to manage because of the relative shortening of the surrounding soft tissue and bone fragility. Our staged approach included excision of the pseudarthrosis, gradual soft tissue lengthening by external fixator, and a modified Sofield-Millar operation, to achieve union, deformity, and limb length correction without compromising much of the bone length. The patient was able to walk with support within 3 months and independently at 1 year. In this report, the management of the nonunion in osteogenesis imperfecta is discussed, with a focus on its difficulties and the management principles.

A New Approach to the Management of Fixed Flexion Deformity of the Knee Using Ilizarov’s Principle of Distraction Histogenesis: A Preliminary Communication

Fixed flexion deformity (FFD) of the knee causes significant patient disability and is challenging to orthopedic surgeons because of its complexity. A prospective study was conducted using Ilizarov's principles of distraction neohistogenesis and differential distraction and Ilizarov's ring fixator for the correction of this deformity in cases with soft-tissue contracture. This was done without any concurrent bony procedures. A prospective, uncontrolled study of 26 patients (39 knees) was conducted over a 4-year period with prior approval from the local institutional review board. Patients with FFD of the knee without bony ankylosis were treated with knee-spanning 4-ring Ilizarov's frame and gradual differential distraction. All patients showed complete correction of deformity without any significant complications. The results of this uncontrolled study permit the observation that soft-tissue distraction across a joint using Ilizarov's principle results in soft-tissue lengthening and correction of joint deformity caused by contractures. This technique needs further detailed examination.

Staged Lengthening Arthroplasty for Pediatric Osteosarcoma around the Knee

Orthopaedic oncologists often must address leg-length discrepancy after resection of tumors in growing patients with osteosarcoma. There are various alternatives to address this problem. We describe a three-stage procedure: (1) temporary arthrodesis, (2) lengthening by Ilizarov apparatus, and (3) tumor prosthesis. We asked (1) to what extent are affected limbs actually lengthened; (2) how many of the patients who undergo a lengthening procedure eventually achieve joint arthroplasty; and (3) can the three-stage procedure give patients a functioning joint with equalization of limb length? We reviewed 56 patients (younger than 14 years) with osteosarcoma who had staged lengthening arthroplasty between 1991 and 2004. Thirty-five of the 56 patients (63%) underwent soft tissue lengthening, and of these 35, 28 (50% of the original group of 56) had implantation of a mobile joint. Three of the 28 prostheses were later removed owing to infection after arthroplasty. The overall average length gained was 7.8 cm (range, 4-14 cm), and 25 (71%) of the 35 patients had a mobile joint at final followup. The average Musculoskeletal Tumor Society functional score was 23.2 (range, 15-28) and limb-length discrepancy at final followup was 2.6 cm (range, 0-6.5 cm). Although most mobile joints had an acceptable ROM (average, 74.2 degrees ; range, 35 degrees -110 degrees ), extension lag was frequent. Our approach is one option for skeletally immature patients, especially in situations where an expandable prosthesis is not available. However, this technique requires multiple stages and would be inappropriate for patients who cannot accept prolonged functional deficit owing to a limited lifespan or other reasons. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Slotted Acetabular Augmentation, Alone or as Part of a Combined One-stage Approach for Treatment of Hip Dysplasia in Adolescents With Cerebral Palsy: Results and Complications in 19 Hips

Surgical correction for the challenging combined deformities in hip dysplasia associated with cerebral palsy remains controversial. The purpose of this study was to assess the efficacy and determine the role of slotted acetabular augmentation (SAA) for the treatment of neuromuscular hip dysplasia in comparison with other treatment options. We retrospectively analyzed 19 dysplastic hips in 19 patients with cerebral palsy who underwent SAA, alone or as part of a combined 1-stage approach, consisting of soft tissue lengthening and/or a proximal femoral osteotomy, during a 20-year period. The mean age at the time of operation was 14 years and 7 months (range: 12 to 17 years and 11 months). All had a closed triradiate cartilage. In 13 hips, preoperative radiographs showed major aspheric femoral head deformities. All had subluxation or dislocation of the hip and severe acetabular dysplasia, associated with a painful hip in 15 patients. Before operation, the mean migration index was 64+/-18%, the mean Sharp angle was 51+/-4 degrees, and the mean center-edge angle was -4+/-13 degrees. On immediate postoperative radiographs, they were 3+/-5%, 35+/-5 degrees, and 42+/-11 degrees. At final follow-up, the average migration index was 10+/-8%, the mean Sharp angle was 35+/-6 degrees, and the mean center-edge angle was 39+/-13 degrees. Eleven hips required soft tissue lengthening and 5 hips had a proximal femoral osteotomy at the time of the shelf procedure. At the latest follow-up (mean duration: 5 years and 5 months), 16 of the 19 hips remained anatomically reduced. Our results suggest that SAA is a successful procedure to treat advanced neurogenic acetabular dysplasia with or without femoral head deformities in skeletally mature patients.

The use of bioabsorbable screw in a split anterior tibial tendon transfer: a preliminary result

The split anterior tibial tendon transfer is a procedure commonly used to correct equinovarus deformity of the foot, primarily in children with spastic cerebral palsy. The procedure has been reported to yield satisfactory results; it can be combined with other soft tissue lengthening. Typically, the transferred tendon can be fixed by either button, staple, metal screw, or anchored into two bony tunnels. Occasionally, failure to maintain transferred tendon fixation may result from conventional surgical methods and therefore lead to undesirable results. The technique of using bioabsorbable interference screw has been proved to be effective in securing the graft as anterior cruciate ligament reconstruction in knee joint. To our knowledge, only few literatures have reported on the use of bioabsorbable screw in the treatment of tendon transfers around the foot. From 2004 to 2006, split anterior tibial tendon transfers with concomitant tendo-Achilles lengthening were applied to 13 patients (16 feet) who had a dynamic equinovarus deformity secondary to spastic cerebral palsy. Mean age at surgery was 8 years and the average follow-up period was 16 months (range, 12-28 months). A 7 x 23 mm cannulated bioabsorbable interference screw was used to fix the transferred tendon. Postoperatively, we used the rating system of Kling et al. to assess the clinical results. Our findings showed that there were 10 excellent, six good, and no poor results. All patients had improved gait at their latest follow-ups. At final follow-up, there was no graft failures or postoperative complications related to the bioabsorbable screw in our series. Although the study is based on a small number of cases, we suggest this technique is an additional armamentarium in fixation for tendon transfers in children's feet.

Severe Post-Burn Hyperextension of Metatarsophalangeal Joints in a Child With Bilateral Foot Contracture

Achieving a stable plantigrade foot after repair of complex post-burn deformities poses a particularly difficult challenge for the foot and ankle surgeon. We report an unusual case of a child with severe bilateral forefoot contracture deformities treated by soft tissue release and lengthening, and conventional wound coverage with split-thickness skin grafting.