Muscle-tendon surgery in diplegic cerebral palsy: functional and mechanical changes

A prospective assessment of muscle-tendon (M-T) surgery was conducted on 30 patients with spastic diplegia. Muscle-tendon surgery consisted of recessions or releases to improve gait function by correcting restricted joint motion and joint malalignment. Functional-outcome measures included the Gross Motor Function Measure (GMFM) and temporal gait factors. Kinematic gait data were evaluated to determine the mechanical effects. The mean age at surgery was 8.7 years (4-20 years), and 3.5 muscle tendon units per extremity were recessed or released at surgery. The primary kinematic change for the hip and the knee was a shift in the sagittal joint position with minimal effects on overall excursion. Changes in ankle-joint dynamics after gastrocsoleus recessions included a reduction in plantarflexion and a shift in the timing of maximal dorsiflexion to later in stance. Improvements in walking velocity and stride length were evident by 6 month after surgery. Functional changes from M-T surgery included a 25% increase in velocity and an 18% increase in stride length over preoperative values seen at 9 months after surgery. Improvements in these parameters were maintained at 2 years after surgery. The GMFM total score showed minimal change after surgery with improvements occurring primarily in the standing dimension and the walking, running, and jumping dimensions.