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The Influence of Botulinum Toxin A Injections into the Calf Muscles on Genu Recurvatum in Children With Cerebral Palsy

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

With cerebral palsy (CP), an equinus deformity may lead to genu recurvatum. Botulinum toxin A (BtA) injection into the calf muscles is a well-accepted treatment for dynamic equinus deformity.

Questions/purposes

The purpose of this study was to determine whether BtA injections into the calf muscles to decrease equinus would decrease coexisting genu recurvatum in children with diplegic CP.

Methods

In a retrospective study, 13 children (mean age, 5 years) with spastic diplegic CP showing equinus and coexisting primary genu recurvatum, who were treated with BtA injections into the calf muscles, were included. Evaluations were done before and 6 and 18 weeks after intervention using three-dimensional gait analysis and clinical examinations according to a standardized protocol. Basic statistical analyses (power analysis, ANOVA) were performed to compare genu recurvatum before treatment and at 6 and 18 weeks after injection with BtA.

Results

During stance phase, maximum ankle dorsiflexion was increased substantially from −3.0° ± 14.3° before to 6.2° ± 14.2° 6 weeks after the injections. Despite this, with the numbers available, the amount of recurvatum in stance did not improve with treatment at either 6 or 18 weeks. There was significant improvement of knee hyperextension during stance phase of 6.2° between baseline and 18 weeks after BtA injection, but a genu recurvatum was still present in most patients.

Conclusions

Despite improvement of ankle dorsiflexion after injection with BtA, genu recurvatum did not show relevant improvement at 6 or 18 weeks after injection with the numbers available. Because knee hyperextension remained in most patients, other factors leading to genu recurvatum should be taken into consideration. In addition, a botulinum toxin-induced weakness of the gastrocnemius may explain why recurvatum gait was not significantly reduced.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Simone Gantz for completing the statistics in this study, and the staff of Heidelberg’s motion laboratory for assistance in collecting the data.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstr 200a, 69118, Heidelberg, Germany

    Matthias C. M. Klotz MD, Sebastian I. Wolf PhD, Daniel Heitzmann MSc, Simone Gantz MSc, Frank Braatz MD & Thomas Dreher MD

Authors
  1. Matthias C. M. Klotz MD
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  2. Sebastian I. Wolf PhD
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  3. Daniel Heitzmann MSc
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  4. Simone Gantz MSc
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  5. Frank Braatz MD
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Corresponding author

Correspondence to Matthias C. M. Klotz MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Klotz, M.C.M., Wolf, S.I., Heitzmann, D. et al. The Influence of Botulinum Toxin A Injections into the Calf Muscles on Genu Recurvatum in Children With Cerebral Palsy. Clin Orthop Relat Res 471, 2327–2332 (2013). https://doi.org/10.1007/s11999-013-2897-7

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  • DOI: https://doi.org/10.1007/s11999-013-2897-7

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