HEMITRANSPLANTATION OF THE TENDO CALCANEUS IN CHILDREN WITH SPINAL NEUROLOGICAL DISORDERS

In paralytic lesions in which the triceps surae is the only active muscle in the leg, elongation or division of the tendo calcaneus alone may not be enough to prevent recurrence of equinus deformity. In 10 patients (13 limbs) with this pattern of muscle activity, equinus deformity was freated by hemifranspiantation of the tendo calcaneus. At follow-up, which was beyond the end of growth in seven limbs, there was no recurrence of deformity in nine. In three of the four failures, a technical fault may have caused loss of activity in the transplanted part of the tendon. The two-stage operation described is recommended in the management of this pattern of paralytic deformity. Equinus deformity is a common problem in children with spinal neurological disorders. When there is still moderate power of active dorsiflexion, elongation of the tendo calcaneus to correct the deformity often results in weakening of the triceps surae; this seems to balance muscle activity and to prevent recurrence. When dorsiflexion is weak, however, transfer of tendons such as the tibialis posterior to the dorsum of the foot may be needed to restore muscle balance. In some children, the triceps surae is the only muscle acting in the leg, even though such activity may only be a reflex response. For these children elongation of the tendo calcaneus alone is insufficient to prevent recur-rence of the deformity. In 1967, Sharrard suggested that hemitransplantation of the tendo calcaneus might provide a solution to this difficulty. Only long-term follow-up, preferably until after skeletal maturity, can determine the success or failure of correction; this report describes this method for correcting paralytic deformity and the long-term results in 10 patients. PATIENTS AND METHO