Surgical Technique: Tendon Releases

Abstract

Adductor and hip flexor releases are commonly used to treat pathologic hip contractures about the hip in children with neuromuscular conditions such as cerebral palsy. Surgery is performed for a variety of reasons, including efforts to avoid hip subluxation or dislocation, to aid in patient positioning, or to address abnormalities in gait. Psoas tendon releases are typically performed at the pelvic brim, though they occur at the lesser trochanter in some circumstances. Adductor tendon releases occur at their origins, and they can involve a solitary tendon or numerous tendons, depending on the degree of contracture severity. Depending on the approach, caution must be taken to avoid injury to the femoral neurovascular bundle, the obturator nerve, or the lateral femoral cutaneous nerve. Postoperative immobilization focuses on maintaining an appropriate degree of normal hip extension and abduction, usually through the use of casting and intermittent stretching. Complications are few but can involve wound infection, neurovascular injury, excessive hip flexor or adductor weakness, and early contracture recurrence.