Lower extremity surgery in muscular dystrophy

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Neuromuscular Diseases

Background:

• Neuromuscular diseases often lead to progressive musculotendinous contractures, impacting mobility.
• Early treatment may not prevent contractures, necessitating surgical intervention.

Purpose of the Study:

• To evaluate the effectiveness of tendon surgery in correcting contractures in children with neuromuscular diseases.
• To assess the long-term outcomes of hip, knee, and ankle surgery for contracture release.

Main Methods:

• Twenty children with muscular dystrophy underwent hip, knee, and/or ankle surgery.
• Procedures included tenectomies, tenotomies, tendon lengthening, and posterior tibial tendon transfer.
• Range of motion was assessed preoperatively and up to 7.4 years post-surgery.

Main Results:

• Significant improvements were observed in hip extension and adduction contractures.
• Knee flessum showed only slight improvement, with regression noted.
• Ankle equinus deformity was corrected, and posterior tibial tendon transfer improved varus correction.
• Surgery enabled continued device-assisted upright positioning for a mean of 3 years.

Conclusions:

• Hip and ankle surgery effectively release contractures in neuromuscular disease patients.
• Knee surgery is recommended only for severe knee flessum (>30°).
• Extensive tensor fascia lata tenectomy and posterior tibial tendon transfer yield optimal results.
• Surgery is indicated for severe contractures, aiming to improve positioning rather than restore walking ability.