Journal of pediatric orthopedics · 2026
Calcaneal Lengthening Osteotomy in Cerebral Palsy: Does Age at Intervention Influence Outcomes?
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Westberry David E, Bailey Jacob M, Shull Emily R, Layton Branum Bo, Hyer Lauren C
Аннотация
BACKGROUND: The optimal age for calcaneal lengthening osteotomy in children with cerebral palsy remains controversial. Younger age has been suggested as a risk factor for recurrence or overcorrection, but long-term clinical data are limited. The primary purpose of this study was to determine whether age at surgery influences long-term radiographic maintenance of correction and clinical outcomes.
METHODS: A retrospective review was performed of 102 patients (155 feet) with cerebral palsy who underwent lateral column lengthening as part of a foot reconstruction procedure between 1990 and 2020 with a minimum of 5 years of radiographic follow-up. Patients were divided into 2 cohorts based on age at surgery: younger than or equal to 8 years (55 patients, 85 feet) and older than 8 years (47 patients, 70 feet). Radiographic parameters were measured preoperatively and at the latest follow-up. Longitudinal changes were assessed using mixed-effects modeling. Secondary outcomes included revision surgery, persistent pain, and pedobarographic analysis in a subset of patients.
RESULTS: Both cohorts showed significant improvement in nearly all radiographic parameters postoperatively ( P <0.05), with no differences between groups at long-term follow-up. Mixed-effects modeling demonstrated gradual changes in several radiographic measures over time; however, rates of change were similar between cohorts. Revision surgery was performed in 11.8% of feet in the younger cohort and 7.1% in the older cohort ( P >0.05). Overcorrection requiring revision occurred in 2 feet, both in the younger cohort. Persistent pain was reported in ~10% of patients in both groups. Pedobarographic analysis demonstrated improvement in fore-aft loading and directionally more normalized loading in the medial-lateral distribution in both cohorts, although medial-lateral changes were not statistically significant.
CONCLUSIONS: Foot reconstruction involving calcaneal lengthening osteotomy provides radiographic correction and acceptable clinical outcomes in children with cerebral palsy, regardless of whether surgery is performed before or after 8 years of age. Age at surgery was not associated with increased recurrence, revision, or persistent pain at long-term follow-up.
LEVEL OF EVIDENCE: Level III-retrospective comparative study.
METHODS: A retrospective review was performed of 102 patients (155 feet) with cerebral palsy who underwent lateral column lengthening as part of a foot reconstruction procedure between 1990 and 2020 with a minimum of 5 years of radiographic follow-up. Patients were divided into 2 cohorts based on age at surgery: younger than or equal to 8 years (55 patients, 85 feet) and older than 8 years (47 patients, 70 feet). Radiographic parameters were measured preoperatively and at the latest follow-up. Longitudinal changes were assessed using mixed-effects modeling. Secondary outcomes included revision surgery, persistent pain, and pedobarographic analysis in a subset of patients.
RESULTS: Both cohorts showed significant improvement in nearly all radiographic parameters postoperatively ( P <0.05), with no differences between groups at long-term follow-up. Mixed-effects modeling demonstrated gradual changes in several radiographic measures over time; however, rates of change were similar between cohorts. Revision surgery was performed in 11.8% of feet in the younger cohort and 7.1% in the older cohort ( P >0.05). Overcorrection requiring revision occurred in 2 feet, both in the younger cohort. Persistent pain was reported in ~10% of patients in both groups. Pedobarographic analysis demonstrated improvement in fore-aft loading and directionally more normalized loading in the medial-lateral distribution in both cohorts, although medial-lateral changes were not statistically significant.
CONCLUSIONS: Foot reconstruction involving calcaneal lengthening osteotomy provides radiographic correction and acceptable clinical outcomes in children with cerebral palsy, regardless of whether surgery is performed before or after 8 years of age. Age at surgery was not associated with increased recurrence, revision, or persistent pain at long-term follow-up.
LEVEL OF EVIDENCE: Level III-retrospective comparative study.