Compartmental pressure after percutaneous tenotomy of the Achilles tendon in children with infantile cerebral palsy.

Purpose: Our objective was to study the pressure of the posterior superficial compartment of legs of children with spastic cerebral palsy and equinus deformity before and after a percutaneous tenotomy of the Achilles tendon.

Methods: We studied compartmental pressure in 28 percutaneous tenotomies of the Achilles tendon (18 patients). All patients suffered cerebral palsy: 19 were tetraplegics (67.9%) (Ashworth Grade 4, Gross Motor Function Classification System (GMFCS) Level IV), and 9 were hemiplegics (32.1%) (Ashworth Grade 3, GMFCS Level III). Exclusions were previous surgery and those who had previously been treated with botulinum toxin. An auto-calibration monitor (measurement error ±1 mmHg) was used to calculate the pressure of the posterior superficial compartment of the leg. The ankle equinus was measured using a goniometer (measurement error ±2°). The systolic and diastolic arterial pressures and the weight were measured simultaneously.

Statistics: Descriptives, Wilcoxon test, and Kruskal-Wallis test were performed.

Results: The mean total age was 9.1 years, the mean total weight was 27.7 kg, and the mean systolic and diastolic pressures were 96.4 and 43.6 mmHg, respectively. The compartmental pressure was 11.3 mmHg pre-tenotomy and decreased by 30.1% post-tenotomy to 7.9 mmHg. Compartmental pressure pre-tenotomy was 10.2 mmHg in hemiplegics and 11.8 mmHg in tetraplegics and was reduced to 2.3 and 10.5 mmHg post-tenotomy in hemiplegics and tetraplegics, respectively. The pressure was significantly reduced in post-tenotomy hemiplegics (p = 0.001). Compartmental pressure was independent of weight, systolic/diastolic pressure, both pre- and post-tenotomy.

Conclusions: Compartmental pressure decreased significantly in spastic boys after percutaneous tenotomy of the Achilles tendon. Compartmental pressure was higher in tetraplegic than in hemiplegic boys.