Evaluating the Role of Gracilis Release in Correcting Spastic In-Toeing Gait in Spastic Cerebral Palsy: A Case Report

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Jan 1

PMID 38161526

Authors

Saksham Goyal

Ratnakar Ambade

Suhas Landge

Adarsh Jayasoorya

Rohan Chandanwale

Affiliations

Soon will be listed here.

Abstract

Cerebral palsy (CP) encompasses a range of conditions that impact an individual's mobility, balance, and posture, making it the most prevalent motor impairment in children. In spastic cerebral palsy, muscle stiffness hinders walking and, if left untreated, may lead to complications such as hip dislocations or dysplasia. Adductor spasticity is a common challenge in these children, significantly impeding mobility and daily activities. The risk of hip dislocation escalates as gross motor function declines, particularly in children with severe impairments. This case report highlights the successful application of bilateral adductor tenotomy with gracilis release in a 9-year-old child diagnosed with spastic cerebral palsy, exhibiting a scissoring and in-toeing gait. Additionally, this report prompts consideration of the potential benefits of gracilis release in addressing the in-toeing gait observed in children affected by spastic cerebral palsy.

References

Bowen J, MacEwen G, Mathews P . Treatment of extension contracture of the hip in cerebral palsy. Dev Med Child Neurol. 1981; 23(1):23-9. DOI: 10.1111/j.1469-8749.1981.tb08443.x. View

Moreau M, Drummond D, Rogala E, Ashworth A, Porter T . Natural history of the dislocated hip in spastic cerebral palsy. Dev Med Child Neurol. 1979; 21(6):749-53. DOI: 10.1111/j.1469-8749.1979.tb01696.x. View

Armand S, Decoulon G, Bonnefoy-Mazure A . Gait analysis in children with cerebral palsy. EFORT Open Rev. 2017; 1(12):448-460. PMC: 5489760. DOI: 10.1302/2058-5241.1.000052. View

Kiapekos N, Brostrom E, Hagglund G, Astrand P . Primary surgery to prevent hip dislocation in children with cerebral palsy in Sweden: a minimum 5-year follow-up by the national surveillance program (CPUP). Acta Orthop. 2019; 90(5):495-500. PMC: 6746285. DOI: 10.1080/17453674.2019.1627116. View

SAMILSON R, Carson J, James P, RANEY Jr F . Results and complications of adductor tenotomy and obturator neurectomy in cerebral palsy. Clin Orthop Relat Res. 1967; 54:61-73. View

Onimus M, Allamel G, MANZONE P, Laurain J . Prevention of hip dislocation in cerebral palsy by early psoas and adductors tenotomies. J Pediatr Orthop. 1991; 11(4):432-5. DOI: 10.1097/01241398-199107000-00002. View

Kalen V, BLECK E . Prevention of spastic paralytic dislocation of the hip. Dev Med Child Neurol. 1985; 27(1):17-24. DOI: 10.1111/j.1469-8749.1985.tb04520.x. View

Hoffer M . Management of the hip in cerebral palsy. J Bone Joint Surg Am. 1986; 68(4):629-31. View

Howard C, MCKIBBIN B, Williams L, Mackie I . Factors affecting the incidence of hip dislocation in cerebral palsy. J Bone Joint Surg Br. 1985; 67(4):530-2. DOI: 10.1302/0301-620X.67B4.4030844. View

10.

Cornell M, Hatrick N, Boyd R, Baird G, Spencer J . The hip in children with cerebral palsy. Predicting the outcome of soft tissue surgery. Clin Orthop Relat Res. 1997; (340):165-71. DOI: 10.1097/00003086-199707000-00021. View

11.

SHARRARD W, Allen J, Heaney S . Surgical prophylaxis of subluxation and dislocation of the hip in cerebral palsy. J Bone Joint Surg Br. 1975; 57(2):160-6. View

12.

Steinbok P . Selection of treatment modalities in children with spastic cerebral palsy. Neurosurg Focus. 2006; 21(2):e4. DOI: 10.3171/foc.2006.21.2.5. View