Isolated calf lengthening in cerebral palsy - Outcome analysis of risk factors

We assessed the medium-term outcome of three methods of isolated calf lengt hening in cerebral palsy by clinical examination, observational gait analys is and, where appropriate, instrumented gait analysis, The procedures used were percutaneous lengthening of tendo Achillis, open Z-lengthening of tend o Achillis and lengthening of the gastrosoleus aponeurosis (Baker's procedu re). We reviewed 195 procedures in 134 children; 45 had hemiplegia, 65 diplegia and 24 quadriplegia, We established the incidence of calcaneus and recurren t equinus and identified 'at-risk' groups for each. At follow-up, 425 had s atisfactory calf length, 22% had recurrent equinus and 36% calcaneus, The i ncidence of calcaneus in girls at follow-up was significantly higher (p = 0 .002) while boys had an increased rate of recurrent equinus (p = 0.012). Children with diplegia who had surgery when aged eight years or younger had a 44% risk of calcaneus, while those over eight years had a 19% risk (0 = 0.046). Percutaneous lengthening of tendo Achillis in diplegia was the leas t predictable, only 38% having a satisfactory outcome compared with 50% in the other procedures. The incidence of recurrent equinus in hemiplegic patients was 38%, Only 4% developed calcaneus, The type of surgery did not influence the outcome in p atients with hemiplegia or quadriplegia. Severity of involvement, female gender, age at operation of less than eight gears and percutaneous lengthening of tendo Achillis were 'risk factors' f or calcaneus, Hemiplegia, male gender, and an aponeurosis muscle lengthenin g increased the risk of recurrent equinus.