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Effects of open adductor tenotomy and adductor muscle botulinum toxin A injection on the hip instability in spastic type cerebral palsy

Year 2022, Volume: 47 Issue: 2, 511 - 518, 30.06.2022
https://doi.org/10.17826/cumj.1002995

Abstract

Purpose: We aimed to evaluate the clinical and radiographic outcomes of hip instability in children with spastic-type Cerebral Palsy (CP) who had undergone open Adductor Tenotomy (AT) or received Botulinum Toxin-A (BTX-A) injections to the hip adductor muscles .
Materials and Methods: Maximum Hip Abduction Angles (MHAA) with the knees and hips in extension were measured preoperatively and the latest clinical findings of all patients in the AT and BTX-A groups were recorded. Reimers’ Migration Percentage (RMP) was measured as the radiographic assessment in the AT group.
Results: There were 30 patients (mean age: 8.3 years) in the AT Group and 25 (mean age: 5.9 years) in the BTX-A Group whose clinical and radiographic data were available. The mean follow-up period in the AT Group was 29.6 months. In the AT Group, the mean MHAA before surgery and at the last assessment were 21.20 and 37.10 respectively. In the BTX-A Group, the mean MHAA before the injection and at the latest assessment were 25.30 and 34.20 respectively. The change in the mean MHAA in the AT Group was 16.20 and 8.80 in the BTX-A Group. In the AT Group, the preoperative RMP was 28.2% and the latest RMP was 22.2%.
Conclusion: AT and BTX-A injections significantly improved hip abduction angles. However, AT provided better clinical improvement and considerable radiographic correction in pediatric patients with spastic-type CP and hip instability.

References

  • 1. Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics. 2012;130:1285-1312.
  • 2. Yildiz C, Demirkale I. Hip problems in cerebral palsy: Screening, diagnosis and treatment. Curr Opin Pediatr. 2014;26:85-92.
  • 3. Spiegel DA, Flynn JM. Evaluation and treatment of hip dysplasia in cerebral palsy. Orthop Clin North Am. 2006;37:185-96.
  • 4. Robin J, Graham HK, Selber P, Dobson F, Smith K, Baker R. Proximal femoral geometry in cerebral palsy: A population-based cross-sectional study. J Bone and Joint Surg Br. 2008;90:1372-9.
  • 5. Soo B, Howard JJ, Boyd RN, Reid SM, Lanigan A, Wolfe R et al. Hip displacement in cerebral palsy. J Bone and Joint Surg. 2006;88(1):121-9.
  • 6. Dobson F, Boyd RN, Parrott J, Nattrass GR, Graham HK. Hip surveillance in children with cerebral palsy. Impact on the surgical management of spastic hip disease. J Bone Joint Surg Br. 2002;84:720-6.
  • 7. Piasek R, Snela S, Rydzak B. Effectiveness of two methods of treatment of the spastic hip in CP children. Ortop Traumatol Rehabil. 2011;13:185-9.
  • 8. Flynn JM, Miller F. Management of hip disorders in patients with cerebral palsy. J Am Acad Orthop Surg. 2002;10:198-209.
  • 9. Pap K, Kiss S, Vízkelety T, Szoke G. Open adductor tenotomy in the prevention of hip subluxation in cerebral palsy. Int Orthop. 2005;29:18-20.
  • 10. Terjesen T, Lie GD, Hyldmo AA, Knaus A. Adductor tenotomy in spastic cerebral Palsy. A long-term follow-up study of 78 patients. Acta Orthop. 2005;76:128-37.
  • 11. Willoughby K, Ang SG, Thomason P, Graham HK. The impact of botulinum toxin A and abduction bracing on long-term hip development in children with cerebral palsy. Dev Med Child Neurol. 2012;54:743-7.
  • 12. Shore B, Spence D, Graham H. The role for hip surveillance in children with cerebral palsy. Curr Rev Musculoskelet Med. 2012;5:126-34.
  • 13. Palisiano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39:214-23.
  • 14. Gordon GS, Simkiss DE. A systematic review of the evidence for hip surveillance in children with cerebral palsy. J Bone Joint Surg Br. 2006;88:1492-6.
  • 15. Divecha A, Bhaskar A. Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy. Indian J Orthop. 2011;45:548-52. 16. Reimers J. The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthop Scand. 1980;184:1-10.
  • 17. Scrutton D, Baird G, Smeeton N. Hip dysplasia in bilateral cerebral palsy: Incidence and natural history in children aged 18 months to 5 years. Dev Med Child Neurol. 2001;43:586-600.
  • 18. Miller F, Bagg MR. Age and migration percentage as risk factors for progression in spastic hip diseases. Dev Med Child Neurol. 1995;37: 449-55.
  • 19. Bishay SN. Short-term results of musculotendinous release for paralytic hip subluxation in children with spastic cerebral palsy. Ann R Coll Surg Engl. 2008;90:127-32.
  • 20. Shore B, Yu X, Desai S, Selber P, Wolfe R, Graham HK. Adductor surgery to prevent hip displacement in children with cerebral palsy: The predictive role of the gross motor function classification system. J Bone Joint Surg Am. 2012;94:323-34.
  • 21. Turker RJ, Lee R. Adductor tenotomies in children with quadriplegic cerebral palsy: Longer term follow-up. J Pediatr Orthop. 2000;20:370-4.
  • 22. Presedo A, Oh CW, Dabney KW, Miller F. Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy. J Bone Joint Surg Am. 2005;87(4):832-41.
  • 23. El Hage S, Rachkidi R, Noun Z, Haidar R. Is percutaneous adductor tenotomy as effective and safe as the open procedure? J Pediatr Orthop. 2010;30:485-8.
  • 24. Rutz E, Vavken P, Camathias C, Haase C, Jünemann S, Brunner R. Long-term results and outcome predictors in one-stage hip reconstruction in children with cerebral palsy. J Bone Joint Surg Am. 2015;18;97(6):500-6.
  • 25. Mall V, Heinen F, Siebel A, Bertram C, Hafkemeyer U, Wissel J et al. Treatment of adductor spasticity with BTX-A in children with CP: A randomized, double-blind, placebo-controlled study. Dev Med Child Neurol. 2006;48:10-3.
  • 26. Graham HK, Boyd R, Carlin JB, Dobson F, Lowe K, Nattrass G et al. Does botulinum toxin A combined with bracing prevent hip displacement in children with cerebral palsy and “Hips at Risk”? A randomized, controlled trial. J Bone Joint Surg Am. 2008;90:23-33.
  • 27. Choi JY, Kim SK, Park ES. The effect of botulinum toxin injections on gross motor function for lower limb spacticity in children with cerebral palsy. Toxins. 2019;11:651.

Spastik tip serebral palside açık addüktör tenotomi ve addüktör kas botulinum toksin-A enjeksiyonunun kalça eklemi instabilitesine etkileri

Year 2022, Volume: 47 Issue: 2, 511 - 518, 30.06.2022
https://doi.org/10.17826/cumj.1002995

Abstract

Amaç: Bu çalışmada Spastik tip serebral palsi (SP) tanılı hastalarda kalça instabilitesi nedeniyle açık addüktör tenotomi (AT) yapılanlar ile addüktör kaslara Botulinum toksin-A (BTX-A) enjeksiyonu yapılanların klinik ve radyolojik sonuçlarının değerlendirilmesi ve karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Hem AT grubunda hem de BTX-A grubunda kalça ve diz eklemleri tam ekstansiyonda iken maksimum kalça abdüksiyon açısı (MKAA) ölçüldü. MKAA’nın işlem öncesi değerleri ile son klinik muayenede elde edilen değerleri karşılaştırıldı. Bu ölçüme ek olarak AT grubunda kalça radyografileri üzerinde Reimers migrasyon yüzdesi (RMY) ölçüldü.
Bulgular: AT grubunda 30 (ortalama yaş: 8.3), BTX grubunda ise 25 (ortalama yaş: 5.9) hasta mevcuttu. Ortalama takip süresi AT grubunda 29.6 ay idi. AT grubunda ameliyat öncesi muayenede ve son muayenede ölçülen MKAA değerleri sırasıyla 21.20 ve 37.10 idi. BTX-A grubunda enjeksiyon öncesi muayenede ve son muayenede ölçülen MKAA değerleri sırasıyla 25.30 ve 34.20 idi. MKAA değerinin değişim miktarı ortalaması AT grubunda 16.20, BTX-A grubunda ise 8.80 idi. AT grubunda ameliyat öncesi RMY ortalaması %28.2, son muayene ortalaması ise %22.2 idi.
Sonuç: Hem AT grubunda hem de BTX-A grubunda kalça abdüksiyon açıları anlamlı düzeyde artmasına rağmen AT grubunda bu artış BTX-A grubuna kıyasla daha fazla olmaktadır. Ek olarak AT grubunda radyolojik olarak belirgin düzelme gözlenmektedir.

References

  • 1. Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics. 2012;130:1285-1312.
  • 2. Yildiz C, Demirkale I. Hip problems in cerebral palsy: Screening, diagnosis and treatment. Curr Opin Pediatr. 2014;26:85-92.
  • 3. Spiegel DA, Flynn JM. Evaluation and treatment of hip dysplasia in cerebral palsy. Orthop Clin North Am. 2006;37:185-96.
  • 4. Robin J, Graham HK, Selber P, Dobson F, Smith K, Baker R. Proximal femoral geometry in cerebral palsy: A population-based cross-sectional study. J Bone and Joint Surg Br. 2008;90:1372-9.
  • 5. Soo B, Howard JJ, Boyd RN, Reid SM, Lanigan A, Wolfe R et al. Hip displacement in cerebral palsy. J Bone and Joint Surg. 2006;88(1):121-9.
  • 6. Dobson F, Boyd RN, Parrott J, Nattrass GR, Graham HK. Hip surveillance in children with cerebral palsy. Impact on the surgical management of spastic hip disease. J Bone Joint Surg Br. 2002;84:720-6.
  • 7. Piasek R, Snela S, Rydzak B. Effectiveness of two methods of treatment of the spastic hip in CP children. Ortop Traumatol Rehabil. 2011;13:185-9.
  • 8. Flynn JM, Miller F. Management of hip disorders in patients with cerebral palsy. J Am Acad Orthop Surg. 2002;10:198-209.
  • 9. Pap K, Kiss S, Vízkelety T, Szoke G. Open adductor tenotomy in the prevention of hip subluxation in cerebral palsy. Int Orthop. 2005;29:18-20.
  • 10. Terjesen T, Lie GD, Hyldmo AA, Knaus A. Adductor tenotomy in spastic cerebral Palsy. A long-term follow-up study of 78 patients. Acta Orthop. 2005;76:128-37.
  • 11. Willoughby K, Ang SG, Thomason P, Graham HK. The impact of botulinum toxin A and abduction bracing on long-term hip development in children with cerebral palsy. Dev Med Child Neurol. 2012;54:743-7.
  • 12. Shore B, Spence D, Graham H. The role for hip surveillance in children with cerebral palsy. Curr Rev Musculoskelet Med. 2012;5:126-34.
  • 13. Palisiano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39:214-23.
  • 14. Gordon GS, Simkiss DE. A systematic review of the evidence for hip surveillance in children with cerebral palsy. J Bone Joint Surg Br. 2006;88:1492-6.
  • 15. Divecha A, Bhaskar A. Utility of combined hip abduction angle for hip surveillance in children with cerebral palsy. Indian J Orthop. 2011;45:548-52. 16. Reimers J. The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthop Scand. 1980;184:1-10.
  • 17. Scrutton D, Baird G, Smeeton N. Hip dysplasia in bilateral cerebral palsy: Incidence and natural history in children aged 18 months to 5 years. Dev Med Child Neurol. 2001;43:586-600.
  • 18. Miller F, Bagg MR. Age and migration percentage as risk factors for progression in spastic hip diseases. Dev Med Child Neurol. 1995;37: 449-55.
  • 19. Bishay SN. Short-term results of musculotendinous release for paralytic hip subluxation in children with spastic cerebral palsy. Ann R Coll Surg Engl. 2008;90:127-32.
  • 20. Shore B, Yu X, Desai S, Selber P, Wolfe R, Graham HK. Adductor surgery to prevent hip displacement in children with cerebral palsy: The predictive role of the gross motor function classification system. J Bone Joint Surg Am. 2012;94:323-34.
  • 21. Turker RJ, Lee R. Adductor tenotomies in children with quadriplegic cerebral palsy: Longer term follow-up. J Pediatr Orthop. 2000;20:370-4.
  • 22. Presedo A, Oh CW, Dabney KW, Miller F. Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy. J Bone Joint Surg Am. 2005;87(4):832-41.
  • 23. El Hage S, Rachkidi R, Noun Z, Haidar R. Is percutaneous adductor tenotomy as effective and safe as the open procedure? J Pediatr Orthop. 2010;30:485-8.
  • 24. Rutz E, Vavken P, Camathias C, Haase C, Jünemann S, Brunner R. Long-term results and outcome predictors in one-stage hip reconstruction in children with cerebral palsy. J Bone Joint Surg Am. 2015;18;97(6):500-6.
  • 25. Mall V, Heinen F, Siebel A, Bertram C, Hafkemeyer U, Wissel J et al. Treatment of adductor spasticity with BTX-A in children with CP: A randomized, double-blind, placebo-controlled study. Dev Med Child Neurol. 2006;48:10-3.
  • 26. Graham HK, Boyd R, Carlin JB, Dobson F, Lowe K, Nattrass G et al. Does botulinum toxin A combined with bracing prevent hip displacement in children with cerebral palsy and “Hips at Risk”? A randomized, controlled trial. J Bone Joint Surg Am. 2008;90:23-33.
  • 27. Choi JY, Kim SK, Park ES. The effect of botulinum toxin injections on gross motor function for lower limb spacticity in children with cerebral palsy. Toxins. 2019;11:651.
There are 26 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Zeynel Mert Asfuroğlu 0000-0001-8796-4133

Kemal Gökhan Günel 0000-0002-9446-1021

Hakan Ömeroğlu 0000-0002-2523-0115

Publication Date June 30, 2022
Acceptance Date February 4, 2022
Published in Issue Year 2022 Volume: 47 Issue: 2

Cite

MLA Asfuroğlu, Zeynel Mert et al. “Effects of Open Adductor Tenotomy and Adductor Muscle Botulinum Toxin A Injection on the Hip Instability in Spastic Type Cerebral Palsy”. Cukurova Medical Journal, vol. 47, no. 2, 2022, pp. 511-8, doi:10.17826/cumj.1002995.