The anteromedial approach to the psoas tendon in patients with cerebral palsy.

Abstract

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. 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.