Effects of open adductor tenotomy and adductor muscle botulinum toxin A injection on the hip instability in spastic type cerebral palsy

Abstract

Purpose: We aimed to evaluate the clinical and radiographic outcomes of hip instability in children with spastic-type Cerebral Palsy (CP) who had undergone open Adductor Tenotomy (AT) or received Botulinum Toxin-A (BTX-A) injections to the hip adductor muscles . Materials and Methods: Maximum Hip Abduction Angles (MHAA) with the knees and hips in extension were measured preoperatively and the latest clinical findings of all patients in the AT and BTX-A groups were recorded. Reimers' Migration Percentage (RMP) was measured as the radiographic assessment in the AT group. Results: There were 30 patients (mean age: 8.3 years) in the AT Group and 25 (mean age: 5.9 years) in the BTX-A Group whose clinical and radiographic data were available. The mean follow-up period in the AT Group was 29.6 months. In the AT Group, the mean MHAA before surgery and at the last assessment were 21.20 and 37.10 respectively. In the BTX-A Group, the mean MHAA before the injection and at the latest assessment were 25.30 and 34.20 respectively. The change in the mean MHAA in the AT Group was 16.20 and 8.80 in the BTX-A Group. In the AT Group, the preoperative RMP was 28.2% and the latest RMP was 22.2%. Conclusion: AT and BTX-A injections significantly improved hip abduction angles. However, AT provided better clinical improvement and considerable radiographic correction in pediatric patients with spastic-type CP and hip instability.