Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: A Delphi consensus study
| العنوان: | Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: A Delphi consensus study |
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| المؤلفون: | Tim Theologis, Thomas Dreher, Matthew Veerkamp, M. Wade Shrader, James J. McCarthy, Tom F. Novacheck, Benjamin J. Shore, Unni G. Narayanan, Jeffrey S. Shilt, Jon R. Davids, Robert M. Kay, Henry G. Chambers, Anja Van Campenhout, H Kerr Graham, Jason Rhodes, Erich Rutz, Kristan Pierz |
| المصدر: | Journal of children's orthopaedics, vol 14, iss 5 Journal of Children's Orthopaedics |
| بيانات النشر: | SAGE Publications, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | medicine.medical_specialty, education, Cerebral palsy, Paediatrics and Reproductive Medicine, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Original Clinical Article, Deformity, medicine, gastrocsoleus lengthening, surgical indications, Orthopedics and Sports Medicine, health care economics and organizations, Pediatric, cerebral palsy, 030222 orthopedics, business.industry, Perinatal Period - Conditions Originating in Perinatal Period, medicine.disease, Gait, humanities, Brain Disorders, Orthopedics, consensus, Pediatrics, Perinatology and Child Health, Ambulatory, Patient Safety, medicine.symptom, business, equinus, 030217 neurology & neurosurgery |
| الوصف: | Purpose Equinus is the most common deformity in cerebral palsy (CP) and gastrocsoleus lengthening (GSL) is the most commonly performed surgery to improve gait and function in ambulatory children with CP. Substantial variation exists in the indications for GSL and surgical technique. The purpose of this study was to review surgical anatomy and biomechanics of the gastrocsoleus and to utilize expert orthopaedic opinion through a Delphi technique to establish consensus for surgical indications for GSL in ambulatory children with CP. Methods A 17-member panel, of Fellowship-trained paediatric orthopaedic surgeons, each with at least 9 years of clinical post-training experience in the surgical management of children with CP, was established. Consensus for the surgical indications for GSL was achieved through a standardized, iterative Delphi process. Results Consensus was reached to support conservative Zone 1 surgery in diplegia and Zone 3 surgery (lengthening of the Achilles tendon) was contraindicated. Zone 2 or Zone 3 surgery reached general agreement as a choice in hemiplegia and under-correction was preferred to any degree of overcorrection. Agreement was reached that the optimum age for GSL surgery was 6 years to 10 years and should be avoided in children aged under 4 years. Physical examination measures with the child awake and under anaesthesia were important in decision making. Gait analysis was supported both for decision making and for assessing outcomes, in combination with patient reported outcomes (PROMS). Conclusions The results from this study may encourage informed practice evaluation, reduce practice variability, improve clinical outcomes and point to questions for further research. Level of Evidence V |
| وصف الملف: | Print; application/pdf |
| تدمد: | 1863-2548 1863-2521 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9982bbc6dbaa548314da8bfc2eeab76a https://doi.org/10.1302/1863-2548.14.200145 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....9982bbc6dbaa548314da8bfc2eeab76a |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 18632548 18632521 |
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