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Comparison of three heel cord surgeries in children with cerebral palsy
Jack R Engsberg1, Donna J Oeffinger, Sandy A Ross
1Human Performance Lab, Dept. of Neurological Surgery, Washington Univ., School of Medicine, St Louis, MO 63110, USA.
Insights
This study compared three heel cord surgeries for children with spastic diplegia cerebral palsy. All procedures improved ankle motion and motor function, but gait speed varied by surgical technique.
Area of Science:
- Orthopedic Surgery
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Spastic diplegia cerebral palsy (CP) often involves equinus foot deformity, impacting gait.
- Heel cord surgery is a common intervention to address this, but optimal technique remains debated.
Purpose of the Study:
- To compare the outcomes of three distinct isolated heel cord surgeries in children with spastic diplegia CP.
- To evaluate the efficacy of heel cord advancement (HCA), Vulpius (HCL-V), and White (HCL-W) lengthening techniques.
Main Methods:
- A nonrandomized prospective descriptive study involving 32 children with spastic diplegia CP.
- Objective outcome measures included ankle range of motion, Gross Motor Function Measure (GMFM), and gait analysis before and 1 year after surgery.
Main Results:
- All three surgical techniques significantly improved passive and active ankle dorsiflexion and GMFM scores.
- Significant improvement in gait speed was observed only in the HCA group, potentially influenced by maturation.
- Heel cord lengthening groups (HCL-V, HCL-W) showed no significant change in gait speed.
Conclusions:
- This study provides the first direct comparison of HCA, HCL-V, and HCL-W surgeries for spastic diplegia CP.
- While all techniques enhance ankle mobility and motor function, surgical choice may influence gait speed outcomes.
Abstract:
This nonrandomized prospective descriptive study compared outcomes of three isolated heel cord surgeries in children with spastic diplegia cerebral palsy (CP): (1) heel cord advancement (HCA), (2) heel cord lengthening according to Vulpius (HCL-V), and (3) heel cord lengthening according to White (HCL-W). Thirty-two children were tested prior to and approximately 1 year after undergoing one of the three surgeries. Objective measures were collected for ankle passive and active range of motion, gross motor function measure (GMFM), and gait. All surgeries indicated significant improvements in end range passive and active ankle dorsiflexion, GMFM, and dorsiflexion during gait. Gait speed was significantly improved for the HCA group, but appeared to be the result of maturity. Gait speed for the HCL-V and HCL-W groups was unchanged. The study was the first to directly compare three heel-cord-lengthening surgeries.