Abstract
Purpose
Release of the psoas tendon for flexion deformity of the hip in children with cerebral palsy has traditionally been performed at the pelvic brim, lateral to the neurovascular bundle, or at its insertion into the lesser trochanter. As the psoas tendon is lateral to the pectineus, the traditional exposure of the tendon through an approach medial to the pectineus is limited by the extent to which the pectineus can be retracted proximally.
Technical note
We describe the use of the anteromedial approach used for the developmentally dislocated hip to expose the psoas tendon between the pectineus and the neurovascular bundle. This provides a much better visualisation of the tendon as it crosses the superior pubic ramus to its insertion. The use of this approach has not been described in cerebral palsy.
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References
Bleck EE (1971) Postural and gait abnormalities caused by hip-flexion deformity in spastic cerebral palsy. J Bone Joint Surg Am 53:1468–1488
Sutherland DH, Zilberfarb JL, Kaufman KR, Wyatt MP, Chambers HG (1997) Psoas release at the pelvic brim in ambulatory patients with cerebral palsy: operative technique and functional outcome. J Pediatr Orthop 17(5):563–570
Matsuo T, Hara H, Tada S (1987) Selective lengthening of the psoas and rectus femoris and preservation of the iliacus for flexion deformity of the hip in cerebral palsy patients. J Pediatr Orthop 7(6):690–698
Weinstein SL (2001) Anteromedial approach to a developmentally dislocated hip. In: Morrissy RT, Weinstein SL (eds) Atlas of pediatric orthopaedic surgery, 3rd edn. Lippincott, Williams & Wilkins, Philadelphia, Pennsylvania, pp 301–308
Ludloff K (1913) The open reduction of the congenital hip dislocation by an anterior incision. Am J Orthop Surg 10:438–454
Mau H, Dorr WM, Henkel L, Lutsche J (1971) Open reduction of congenital dislocation of the hip by Ludloff’s method. J Bone Joint Surg Am 53:1281–1288
Weinstein SL, Ponseti IV (1979) Congenital dislocation of the hip: open reduction through a medial approach. J Bone Joint Surg Am 61:119–124
Morcuende JA, Meyer MD, Dolon LA, Weinstein SL (1997) Long-term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J Bone Joint Surg Am 79:810–817
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Poonnoose, P.M., Madhuri, V. & Palocaren, T. The anteromedial approach to the psoas tendon in patients with cerebral palsy. J Child Orthop 1, 249–252 (2007). https://doi.org/10.1007/s11832-007-0035-3
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DOI: https://doi.org/10.1007/s11832-007-0035-3