Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 20;12(8):e24.00093.
doi: 10.2106/JBJS.RVW.24.00093. eCollection 2024 Aug 1.

Do Adductor Tenotomies Prevent Progressive Migration in Children with Cerebral Palsy?: A Systematic Review

Renée Anne van Stralen  1 , Merel Charlotte Rosalie Roelen  1 , Pranai Buddhdev  2 , Max Reijman  1 , Denise Eygendaal  1 , Jaap Johannes Tolk  1
Affiliations

Do Adductor Tenotomies Prevent Progressive Migration in Children with Cerebral Palsy?: A Systematic Review

Renée Anne van Stralen et al. JBJS Rev. .

Abstract

Background: Up to one-third of children with cerebral palsy (CP) develop migration of the hip, and the risk increases with a higher Gross Motor Function Classification System (GMFCS). In progressive hip migration in young children, adductor tenotomy is an accepted treatment option to delay or prevent progressive hip migration. However, there is quite a large variability in reported results. This systematic review aims to determine the effectiveness of a soft-tissue release in the prevention of progressive hip migration in children with CP.

Methods: This systematic review was performed in accordance with the guidelines of the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statements. Our inclusion criteria were studies describing pediatric, skeletally immature patients with CP and a "hip at risk" of progressive hip migration. Exclusion criteria were simultaneous bony reconstructions, case reports, technical notes, published abstracts, or studies with a follow-up under 1 year postoperatively. The primary outcomes were defined as failure rate (progressive hip migration and/or need for bony surgery, as defined by each paper) and change in migration percentage (MP) at final follow-up. As secondary analyses, we evaluated the outcome after specific subtypes of surgeries and assessed whether performing lengthening of iliopsoas, neurectomy of the anterior branch of the obturator nerve, age at the time of surgery, GMFCS level, and postoperative management impact the outcome.

Results: Our literature search identified 380 titles. Eighty-four articles underwent full-text review, of which 27 met our inclusion/exclusion criteria and were subsequently selected for quantitative analysis. A prevalence meta-analysis was performed including 17 studies (2,213 hips). Mean follow-up ranged from 12 to 148.8 months. The mean preoperative MP was 33.4% (2,740 hips) and 29.9% at follow-up. The overall reported failure rate was 39% (95% confidence interval, 26%-52%). Performing a release of only adductor longus had a failure rate of 87%, whereas more extensive soft-tissue releases showed significantly better results with failure rates ranging from 0 to 44% (p < 0.001). Lengthening of the iliopsoas had no significant impact on failure rate (p = 0.48), nor did performing an obturator neurectomy (p = 0.92).

Conclusion: The failure rate of adductor tenotomies to prevent progressive hip migration appears to be as high as 39% in studies with a varying follow-up. The failure rates are significantly higher when isolated release of the adductor longus is performed. This systematic review supports clinical decision making in children with CP and early hip migration.

Level of evidence: Level IIA. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B129).

Figures

Fig. 1
Fig. 1
Flowchart of inclusion.
Fig. 2
Fig. 2
Meta-analysis of failure rate after adductor tenotomies. CI = confidence interval.
Fig. 3
Fig. 3
Meta-analysis of patients undergoing adductor tenotomies age younger than 4 or older than 4 years. CI = confidence interval.
Fig. 4
Fig. 4
Meta-analysis comparing different types of surgeries. CI = confidence interval.
See this image and copyright information in PMC

References

    1. Gordon GS, Simkiss DE. A systematic review of the evidence for hip surveillance in children with cerebral palsy. J Bone Joint Surg Br. 2006;88(11):1492-6. - PubMed
    1. Hagglund G, Lauge-Pedersen H, Wagner P. Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskelet Disord. 2007;8:101. - PMC - PubMed
    1. Larnert P, Risto O, Hagglund G, Wagner P. Hip displacement in relation to age and gross motor function in children with cerebral palsy. J Child Orthop. 2014;8(2):129-34. - PMC - PubMed
    1. Miller F, Bagg MR. Age and migration percentage as risk factors for progression in spastic hip disease. Dev Med Child Neurol. 1995;37(5):449-55. - PubMed
    1. Soo B, Howard JJ, Boyd RN, Reid SM, Lanigan A, Wolfe R, Reddihough D, Graham HK. Hip displacement in cerebral palsy. J Bone Joint Surg Am. 2006;88(1):121-9. - PubMed

Publication types