Effects of botulinum toxin A on functional outcome during distraction osteogenesis

Ronke Olabisi, Thomas Best, Ray Vanderby, Sarah Petr, Kenneth J. Noonan

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Distraction osteogenesis is useful for correcting limb length inequality, deformities, or short stature. Despite success with bone formation, soft tissue maladaptations including muscle and joint contracture may lead to undesirable results. Botulinum toxin A has been useful in treating spasticity in cerebral palsy, and has been used clinically in select cases to allay contracture in distraction osteogenesis. This study examines the toxin's efficacy in preventing distraction-induced loss of muscle strength and range of motion. The left tibias of 15 New Zealand White rabbits were distracted 1.5 mm/day until approximately a 20% gain was achieved. Each treatment group was divided into animals injected with saline or botulinum toxin in either the gastrocnemius or tibialis anterior muscles. A control group of two additional animals underwent no surgical procedure. Strength and range of motion were assessed prior to, and following, the experiment. At the study's end, animals were euthanized and muscles were harvested, when lengths and weights were recorded. All muscles injected with botulinum toxin showed decreased wet weight and persistent weakness upon completion of the study. Range of motion decreased in all distracted animals. When the gastrocnemius was injected, its strength was reduced but the tibialis anterior strength was preserved, and the limb achieved 22% greater dorsiflexion than saline controls (p = 0.016). When the tibialis anterior received the toxin, plantarflexion was increased by 23% (p = 0.049). Botulinum toxin injection prior to limb distraction increases the "post-lengthened" excursion of the injected muscle and this increased length may have a protective effect on its antagonist. In toxin-injected gastrocnemius muscles, the level of equinus contracture is reduced due to length gains in the Achilles tendon while the anterior tibialis maintains its ability to generate torque. Injection of botulinum toxin in the gastrocnemius may minimize equinus contracture and protect the anterior tibialis from damage during human tibial lengthening. Longer follow-up studies are needed to ensure that toxin-induced muscle weakness resolves with time.

Original languageEnglish (US)
Pages (from-to)656-664
Number of pages9
JournalJournal of Orthopaedic Research
Volume25
Issue number5
DOIs
StatePublished - May 1 2007
Externally publishedYes

Fingerprint

Distraction Osteogenesis
Type A Botulinum Toxins
Botulinum Toxins
Equinus Deformity
Muscles
Articular Range of Motion
Extremities
Contracture
Weights and Measures
Injections
Achilles Tendon
Muscle Weakness
Torque
Muscle Strength
Cerebral Palsy
Tibia
Osteogenesis
Skeletal Muscle
Joints
Rabbits

Keywords

  • Botulinum toxin
  • Callotasis
  • Callus distraction
  • Distraction osteogenesis
  • Limb lengthening
  • Type A

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Effects of botulinum toxin A on functional outcome during distraction osteogenesis. / Olabisi, Ronke; Best, Thomas; Vanderby, Ray; Petr, Sarah; Noonan, Kenneth J.

In: Journal of Orthopaedic Research, Vol. 25, No. 5, 01.05.2007, p. 656-664.

Research output: Contribution to journalArticle

Olabisi, Ronke ; Best, Thomas ; Vanderby, Ray ; Petr, Sarah ; Noonan, Kenneth J. / Effects of botulinum toxin A on functional outcome during distraction osteogenesis. In: Journal of Orthopaedic Research. 2007 ; Vol. 25, No. 5. pp. 656-664.
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