A Comparative Study of Gastrocnemius Recession Alone versus Gastrocnemius Recession Combined with Anterior Tibialis Tendon Transfer for the Management of Severe Equinus Deformity with Dynamic Varus in Ambulatory Children with Cerebral Palsy
Keywords:
Cerebral palsy, Equinus deformity, Gastrocnemius recession, Anterior tibialis tendon transfer, Dynamic varus, Pediatric orthopedics, Gait correctionAbstract
Background: This study compared the clinical and functional outcomes of gastrocnemius recession alone versus gastrocnemius recession combined with anterior tibialis tendon transfer in children with cerebral palsy.
Methods: A prospective comparative study was conducted on 72 ambulatory children with spastic cerebral palsy presenting with severe equinus and dynamic varus between May 2023 and May 2024. Participants were divided into two equal groups: Group A underwent gastrocnemius recession alone, and Group B underwent gastrocnemius recession combined with tibialis anterior transfer. Pre- and postoperative assessment included ankle dorsiflexion angle (knee flexed and extended), dynamic varus correction, foot progression angle, and GMFM-66 functional score. Complications and recurrence rates were recorded. Statistical analysis was performed using independent t-test and chi-square test, with p < 0.05 considered significant.
Results: Both groups showed significant postoperative improvement in dorsiflexion (p < 0.05). Group B demonstrated greater correction of dynamic varus, higher mean improvement in foot progression angle, and a larger gain in GMFM-66 scores (p < 0.05). Recurrence was lower in the combined procedure group, although the difference was not statistically significant. Complication rates were low and comparable between groups.
Conclusion: Combining gastrocnemius recession with anterior tibialis tendon transfer provides superior correction of dynamic varus and improved gait outcomes compared to recession alone. This combined approach should be considered in children with severe equinus and marked dynamic varus to optimize functional mobility and reduce recurrence risk.
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