CHRONOLOGICAL OUTCOME OF SURGICAL TENDOACHILLES LENGTHENING AND NATURAL-HISTORY OF GASTROC-SOLEUS CONTRACTURE IN CEREBRAL-PALSY - A 2-PART STUDY

Medical records of 59 patients with cerebral palsy were reviewed retro spectively to evaluate results of tendoachilles lengthening. Surgical lengthening resulted in highly significant (p < 0.0001) initial averag e gains in dorsiflexion compared with baseline. These average improvem ents maintained their statistical significance for seven years postope ratively. The are of motion was not significantly different postoperat ively. The initial ambulatory level was improved in 55% of the patient s and maintained in the remainder. However, 14 ankles (11.9%) in eight patients (13.6%) required repeat tendoachilles lengthening during the study period, primarily after gastrocnemius procedures. Calcaneus def ormity occurred in 1.7% of the surgically treated ankles. To evaluate the potential for spontaneous improvement over time in fixed equinus d eformity, the records of a group of 68 additional cerebral palsy patie nts were reviewed. Patients treated nonoperatively despite two examina tions that demonstrated fixed lack of dorsiflexion, while not represen ting a true control group, showed no spontaneous improvement in equinu s deformity through seven years postoperatively.