Clinical and Radiological Efficacy of Botulinum Neurotoxin- A or Tenotomy in Cerebral Palsy with Hip Adductor Spasticity

ABS TRACT Objective:To evaluate the clinical and radiological efficacy of tenotomy or sequential botulinum neurotoxin-A (BoNT-A) injection on hip adductor spasticity in children with cerebral palsy (CP).Material and Methods: This was a retrospective study that included 40 patients who underwent sequential BoNT-A injection or tenotomy of the hip adductor muscles.For clinical evaluation, the Modified Ashworth Scale (MAS) scores, and the Gross Motor Function Classification System (GMFCS) levels were recorded from the patient files.Radiological evaluations were performed by measuring the migration index (MI) and head -shaft angle (HSA) on anteroposterior pelvis radiographs.Results: The mean age of patients in the BoNT-A and tenotomy groups was similar (7.951.9 and 8.102.88years, p>0.05, respectively).Although a significant decrease in MAS scores was observed in both groups at 3 rd and 12 th months (p<0.05),there was no difference between the groups (p>0.05).While improvement was observed at the GMFCS level at the 3 rd and 12 th months in the tenotomy group (p<0.05),there was no improvement in the BoNT-A group (p>0.05).After injection, a decrease was detected at MI at 3 rd and 12 th months, but it was not significant (p>0.05).A significant decrease in MI was found at the 3 rd and 12 th months after tenotomy (p<0.05).In both groups, there was no significant improvement in HSA at the 3 rd and 12 th months (p>0.05).Conclusion: In CP with hip adductor spasticity, sequential BoNT-A injections improved the spasticity and prevented the progression of MI.Hip adductor tenotomy resulted in significant improvement in spasticity, GMFCS level, and MI, but did not result in a decrease in HSA.