Article

The aim of this study was to evaluate the outcome of combined tibialis anterior
tendon shortening (TATS) and calf muscle-tendon lengthening (CMTL) in spastic
equinus. Prospectively collected data was analysed in 26 patients with hemiplegic
(n=13) and diplegic (n=13) cerebral palsy (CP) (GMFCS level I or II, 14 males, 12
females, age range 10-35 years; mean 16.8 years).
All patients had pre-operative
3D gait analysis and a further analysis at a mean of 17.1 months (+/-5.6months)
after surgery. None was lost to follow-up. Twenty-eight combined TATS and CMTL
were undertaken and 19 patients had additional synchronous multilevel surgery. At
follow-up 79% of patients had improved foot positioning at initial contact,
whilst 68% reported improved fitting or reduced requirement of orthotic support.
Statistically significant improvements were seen in the Movement Analysis Profile
for ankle dorsi-/plantarflexion (4.15 degrees , p=0.032), maximum ankle
dorsiflexion during swing phase (11.68 degrees , p<0.001), and Edinburgh Visual
Gait Score (EVGS) (4.85, p=0.014). Diplegic patients had a greater improvement in
the EVGS than hemiplegics (6.27 -vs- 2.21, p=0.024). The originators of combined
TATS and CMTL showed that it improved foot positioning during gait. The present
study has independently confirmed favourable outcomes in a similar patient
population and added additional outcome measures, the EVGS, foot positioning at
initial contact, and maximum ankle dorsiflexion during swing phase. Study
limitations include short term follow-up in a heterogeneous population and that
19 patients had additional surgery. TATS combined with CMTL is a recommended
option for spastic equinus in ambulatory patients with CP.
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