Study of Split Tibialis Anterior Tendon Transfer to Peroneus Brevis in Management of Equinovarus Deformity among Children with Cerebral Palsy

Abstract

Background: About one third of kids with spastic hemiplegic cerebral palsy also have equinovarus. For equinovarus deformity, the ideal softtissue surgical treatment is a split transfer of the tibialis anterior tendon.

Objectives: To evaluate the radiological as well as clinical results of split transfer of tibialis anterior to peroneus brevis in management of  equinovarus deformity among children with cerebral palsy.

Subjects and methods: This is interventional clinical trial study that was performed on 18 patients presented to orthopedic department at Zagazig University Hospitals with equinovarus foot deformity  undergone split tibilais anterior transfer to peroneus brevis with fractional lengthening of tibilais posterior and gastrocnemius recession.  

Results: The pain and difficulty of shoe-wearing were improved in all the patients (100.0%). There were 15 patients (83.3%)  had an excellent outcome, and only 3 patients (16.7%) had a good outcome according to Kling’s score. We found a highly statistically  significant decrease (improve) in the GMFC score from (2.3±0.48) to become (1.3±0.47) (p-value<0.001) with a percent of improvement  (50.4%) ranging from (43.1%-69.2%). There were 13 patients (72.2%) didn’t have any complications, two cases (11.1%) had dry, flaky skin &  itching after the cast and three cases (16.7%) had superficial wound infections which treated by parental antibiotics for 2 weeks.  

Conclusion: The benefits of split tibialis anterior transfer to peroneus brevis in treating equinovarus foot deformity in cerebral palsy  patients have been demonstrated by this research. The procedure is technically simple, with high rates of success and minimal  complications.