The Effects of Split Tibialis Anterior Tendon Transfer to the Peroneus Tertius for Equinovarus Foot in Children with Unilateral Cerebral Palsy: Evaluation with the Edinburgh Visual Gait Score

Yıl 2025, Cilt: 5 Sayı: 3, 345 - 354, 31.12.2025

Osman Doğan , Baris Gorgun , Meltem Çelik , Ozan Ali Erdal , İlker Abdullah Sarıkaya , Muharrem Inan

https://doi.org/10.56061/fbujohs.1663980

Öz

This study aimed to objectively evaluate gait quality using the Edinburgh Visual Gait Score (EVGS) after Split Tibialis Anterior Tendon Transfer (STATT) for equinovarus deformity (ED) in children with unilateral cerebral palsy (UCP). Children with UCP who underwent STATT for ED were followed, and data were collected based on the gait observed at the final follow-up. Gait outcomes were assessed using EVGS, and the significance of pre- and postoperative scores was determined. A total of 20 children with UCP were included, with a mean surgery age of 8.3±3.9 years. The mean follow-up period was 43 ± 14 months. Significant improvements were observed in total EVGS scores and specific gait parameters, including initial contact during stance phase, heel lift, maximum dorsiflexion during stance phase, hindfoot varus/valgus position in stance, foot rotation in stance, and maximum ankle dorsiflexion during swing (p <0.001). This study is the first to report the functional outcomes of STATT to the peroneus tertius in children with UCP and ED. Significant improvements in EVGS total scores and specific gait parameters were identified. These findings suggest that STATT improves gait function in children with UCP and may be a valuable surgical approach for managing ED.

Anahtar Kelimeler

Cerebral palsy , observational gait analysis , tibialis anterior , tendon transfer

Unilateral Serebral Palsi’li Çocuklarda Ekinovarus Ayak Deformitesi için Peroneus Tertius’a Yapılan Split Tibialis Anterior Tendon Transferi’nin Etkileri: Edinburgh Görsel Yürüme Skoru ile Değerlendirme

Öz

Bu çalışma, Unilateral serebral palsili (USP) çocuklarda ekinovarus deformitesi (ED) için uygulanan Split Tibialis Anterior Tendon Transferi (STATT) sonrası yürüme kalitesini Edinburgh Görsel Yürüme Skoru (EGYS) kullanarak objektif olarak değerlendirmeyi amaçlamaktadır. ED nedeniyle STATT ameliyatı geçiren USP’li çocuklar yalnızca takip edilerek değerlendirildi ve veriler son takipteki yürüyüşten toplandı. Yürüme sonuçları EVGS kullanılarak değerlendirildi. Ameliyat öncesi ve sonrası EGYS skorlarının anlamlılığı belirlendi. Toplam 20 USP’li çocuk çalışmaya dahil edildi ve ortalama ameliyat yaşı 8,3±3,9 yıl olarak hesaplandı. Ortalama takip süresi 43±14 aydı. Toplam EGYS skorlarında ve belirli yürüme parametrelerinde anlamlı iyileşmeler gözlendi. Bunlar arasında, duruş fazında ilk temas, topuk kalkma anı, duruş fazındaki maksimum dorsifleksiyon, duruş fazındaki arka ayak varus/valgus durumu, duruş fazındaki ayak rotasyonu ve salınım fazındaki maksimum ayak bileği dorsifleksiyonu yer almaktadır (p <0.001). Bu çalışma, USP’li çocuklarda ED tedavisinde peroneus tertius’a yapılan STATT’nin fonksiyonel sonuçlarını bildiren ilk çalışmadır. EVGS toplam skorlarında ve belirli yürüme parametrelerinde anlamlı iyileşmeler tespit edilmiştir. Bu bulgular, STATT’nin USP’li çocuklarda yürüme fonksiyonunu iyileştirdiğini ve ED yönetimi için değerli bir cerrahi yaklaşım olabileceğini göstermektedir.

Anahtar Kelimeler

Serebral palsi , gözlemsel yürüme analizi , tibialis anterior , tendon transferi

Kaynakça

• Aleksić, M., Baščarevic, Z., Stevanović, V., Rakočević, J., Baljozović, A., & Čobeljić, G. (2020). Modified split tendon transfer of posterior tibialis muscle in the treatment of spastic equinovarus foot deformity: Long-term results and comparison with the standard procedure. International Orthopaedics, 44(1), 155-160. https://doi.org/10.1007/s00264-019-04443-6
• Aroojis, A., Sagade, B., & Chand, S. (2021). Usability and Reliability of the Edinburgh Visual Gait Score in Children with Spastic Cerebral Palsy Using Smartphone Slow-Motion Video Technology and a Motion Analysis Application: A Pilot Study. Indian Journal of Orthopaedics, 55(4), 931-938. https://doi.org/10.1007/s43465-020-00332-y
• Barnes, M. J., & Herring, J. A. (1991). Combined split anterior tibial-tendon transfer and intramuscular lengthening of the posterior tibial tendon. Results in patients who have a varus deformity of the foot due to spastic cerebral palsy. The Journal of Bone and Joint Surgery. American Volume, 73(5), 734-738.
• Del Pilar Duque Orozco, M., Abousamra, O., Church, C., Lennon, N., Henley, J., Rogers, K. J., Sees, J. P., Connor, J., & Miller, F. (2016). Reliability and validity of Edinburgh visual gait score as an evaluation tool for children with cerebral palsy. Gait & Posture, 49, 14-18. https://doi.org/10.1016/j.gaitpost.2016.06.017
• Fong, C.-M., Blackburn, J. T., Norcross, M. F., McGrath, M., & Padua, D. A. (2011). Ankle-dorsiflexion range of motion and landing biomechanics. Journal of Athletic Training, 46(1), 5-10. https://doi.org/10.4085/1062-6050-46.1.5
• Hosalkar, H., Goebel, J., Reddy, S., Pandya, N. K., & Keenan, M. A. (2008). Fixation techniques for split anterior tibialis transfer in spastic equinovarus feet. Clinical Orthopaedics and Related Research, 466(10), 2500-2506. https://doi.org/10.1007/s11999-008-0395-0
• Kling, T. F., Kaufer, H., & Hensinger, R. N. (1985). Split posterior tibial-tendon transfers in children with cerebral spastic paralysis and equinovarus deformity. The Journal of Bone and Joint Surgery. American Volume, 67(2), 186-194.
• Limpaphayom, N., Chantarasongsuk, B., Osateerakun, P., & Prasongchin, P. (2015). The split anterior tibialis tendon transfer procedure for spastic equinovarus foot in children with cerebral palsy: Results and factors associated with a failed outcome. International Orthopaedics, 39(8), 1593-1598. https://doi.org/10.1007/s00264-015-2793-8
• Michlitsch, M. G., Rethlefsen, S. A., & Kay, R. M. (2006). The contributions of anterior and posterior tibialis dysfunction to varus foot deformity in patients with cerebral palsy. The Journal of Bone and Joint Surgery. American Volume, 88(8), 1764-1768. https://doi.org/10.2106/JBJS.E.00964
• Perry, J., & Hoffer, M. M. (1977). Preoperative and postoperative dynamic electromyography as an aid in planning tendon transfers in children with cerebral palsy. The Journal of Bone and Joint Surgery. American Volume, 59(4), 531-537.
• Read, H. S., Hazlewood, M. E., Hillman, S. J., Prescott, R. J., & Robb, J. E. (2003). Edinburgh visual gait score for use in cerebral palsy. Journal of Pediatric Orthopedics, 23(3), 296-301.
• Rethlefsen, S. A., Hanson, A. M., Ciccodicola, E., Wren, T. A. L., & Kay, R. M. (2022). Variation in Functional Mobility Within Gross Motor Function Classification System Levels. Journal of Pediatric Orthopedics, 42(4), 209-214. https://doi.org/10.1097/BPO.0000000000002060
• Robinson, L. W., Clement, N., Fullarton, M., Richardson, A., Herman, J., Henderson, G., Robb, J. E., & Gaston, M. S. (2015). The relationship between the Edinburgh Visual Gait Score, the Gait Profile Score and GMFCS levels I-III. Gait & Posture, 41(2), 741-743. https://doi.org/10.1016/j.gaitpost.2015.01.022
• Sarıkaya, İ. A., Birsel, S. E., Şeker, A., Erdal, O. A., Görgün, B., & İnan, M. (2020). The split transfer of tibialis anterior tendon to peroneus tertius tendon for equinovarus foot in children with cerebral palsy. Acta Orthopaedica Et Traumatologica Turcica, 54(3), 262-268. https://doi.org/10.5152/j.aott.2020.03.571
• Schwend, R. M., & Drennan, J. C. (2003). Cavus foot deformity in children. The Journal of the American Academy of Orthopaedic Surgeons, 11(3), 201-211. https://doi.org/10.5435/00124635-200305000-00007
• Wu, K.-W., Huang, S.-C., Kuo, K. N., & Wang, T.-M. (2009). The use of bioabsorbable screw in a split anterior tibial tendon transfer: A preliminary result. Journal of Pediatric Orthopedics. Part B, 18(2), 69-72. https://doi.org/10.1097/bpb.0b013e328329429a
• Yngve, D. A. (2021). Recurvatum of the Knee in Cerebral Palsy: A Review. Cureus, 13(4), e14408. https://doi.org/10.7759/cureus.14408