Surgical correction of equinus deformity in children with cerebral palsy: a systematic review

Area of Science:

• Orthopaedic surgery
• Pediatric neurology
• Rehabilitation medicine

Background:

• Equinus deformity is the most prevalent musculoskeletal issue in individuals with cerebral palsy (CP).
• Existing literature on surgical interventions for CP-related equinus is extensive but often lacks robust evidence.
• There is a critical need to evaluate the current evidence base for surgical approaches to equinus deformity in CP.

Purpose of the Study:

• To systematically review and assess the quality of evidence supporting surgical management of equinus deformity in cerebral palsy.
• To identify factors influencing surgical outcomes for equinus deformity in the context of cerebral palsy.

Main Methods:

• A systematic literature search was conducted using keywords: "equinus deformity", "cerebral palsy", and "orthopaedic surgery".
• 35 articles were included after applying predefined inclusion and exclusion criteria.
• Evidence quality was assessed using the Oxford Centre for Evidence-Based Medicine (CEBM) levels and the Methodological Index for Non-Randomized Studies (MINORS).

Main Results:

• Studies analyzed involved 9 to 156 subjects (average 38), with mean ages at surgery ranging from 5 to 19 years.
• Instrumented gait analysis was used in 19 studies, with an average follow-up of 2.8 years.
• Younger age at surgery correlated with a higher risk of recurrent equinus; calcaneus rates were 1% in hemiplegia and 15% in spastic diplegia.
• The majority of studies were Level 4 evidence, yielding only Grade C recommendations.

Conclusions:

• Cerebral palsy subtype (hemiplegia vs. diplegia) and age at the time of surgery are critical determinants of surgical success for equinus deformity.
• Evidence supporting specific surgical procedures over others for equinus deformity in CP is limited.
• Future research should focus on higher-quality studies to guide surgical decision-making in this population.