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Percutaneous Adductor Release in Nonambulant Children with Cerebral Palsy
1SMS & RI Sharda University, Uttar Pradesh, India.
Insights
Percutaneous adductor release effectively improved hip function in children with spastic cerebral palsy. Early intervention with this procedure can prevent hip subluxation and reduce the need for future surgeries.
Area of Science:
- Orthopedic Surgery
- Pediatric Rehabilitation
- Neuromuscular Disorders
Background:
- Adductor spasticity in the hips is a primary impediment to functional activities and rehabilitation in children with spastic cerebral palsy.
- Percutaneous adductor release is a surgical option for managing this condition.
Purpose of the Study:
- To evaluate the clinical and radiological outcomes of percutaneous adductor release under general anesthesia in children with cerebral palsy.
- To assess the impact of the procedure on hip joint parameters and functional activity levels.
Main Methods:
- A cohort of 32 children (64 hips) with adductor contracture due to cerebral palsy underwent percutaneous adductor release.
- Patients were followed for 24 months, with radiological assessment including CE-angle, AC-index, and femoral head coverage.
- Functional activity levels were also evaluated.
Main Results:
- Twenty-eight children demonstrated marked and immediate improvement, with no cases showing functional decline.
- The AC-index showed significant improvement (P = 0.01), while CE-angle and femoral head coverage remained statistically unchanged.
- Excellent outcomes were observed in 12.5%, good in 50%, fair in 25%, and poor in 12.5% of cases.
Conclusions:
- Bilateral mini-invasive adductor release is an effective treatment for adductor contracture unresponsive to conservative management in children with cerebral palsy.
- Early adductor release may prevent hip subluxation and potentially obviate the need for future reconstructive surgery of the proximal femur and pelvis.
Introduction:
Adductor spasticity at hips is the main barrier in functional activities and rehabilitation of spastic cerebral palsy patients. The aim of this study is to evaluate the results of percutaneous adductor release under general anaesthesia.
Methods:
From July 2005 to July 2010, 64 hips in 32 patients (19 males and 13 females) were recruited from outpatient department having adductor contracture at hips in cerebral palsy children. All children were operated under general anaesthesia. All children were followed for twenty-four months. The clinical results were evaluated radiologically, including measurement of CE- angle, AC-index and femoral head coverage and in terms of activity level of children.
Results:
Of the thirty-two children, twenty-eight showed marked and immediate improvement. None of our children was functionally worse at follow-up. The CE-angle and femoral head coverage did not change significantly. The AC-index improved significantly (P = 0.01).The results were excellent in 12.5% children, good in 50%, fair in 25% and poor in 12.5%.
Conclusions:
Bilateral mini-invasive adductor release can be an effective treatment for children suffering from adductor contracture refractory to nonoperative management and early adductor release can prevent subluxation and possibly the need for future bony procedure on the proximal femur and pelvis.
