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Rectus and hamstring surgery in cerebral palsy: a gait analysis study of results by functional ambulation level
David A Yngve1, Nancy Scarborough, Barry Goode
1Shriners Hospital for Children, Houston, Texas, USA. yngve@utmb.edu
Insights
Children with cerebral palsy (CP) showed improved walking after rectus transfer and hamstring surgery, regardless of initial severity. Even those with severe CP experienced gains in knee motion and stride length.
Area of Science:
- Orthopedic surgery
- Pediatric rehabilitation
- Cerebral palsy research
Background:
- Cerebral palsy (CP) significantly impacts ambulation in children.
- Rectus transfer and hamstring surgery are interventions to improve gait in CP.
- Understanding functional outcomes across different CP severity levels is crucial.
Purpose of the Study:
- To evaluate the efficacy of rectus transfer and hamstring surgery in children with CP.
- To compare surgical outcomes between children with varying degrees of CP involvement.
- To assess improvements in gait parameters and functional ambulation post-surgery.
Main Methods:
- Ninety-nine children with CP were categorized into three functional ambulation groups.
- Surgical interventions included rectus transfer and hamstring procedures.
- Gait analysis and functional ambulation levels were assessed pre- and post-surgery.
Main Results:
- All patient groups demonstrated increased maximum knee extension and total range of knee motion.
- Gait timing, including peak knee flexion in swing, improved across all severity levels.
- Stride length increased in all groups; walking speed improved in the household/exercise group.
- A significant number of participants progressed to a higher functional ambulation category post-surgery.
Conclusions:
- Rectus transfer and hamstring surgery yield positive functional outcomes in children with CP.
- Surgical benefits, including improved gait parameters, are observed across all CP severity levels.
- These surgical interventions can lead to enhanced ambulation and functional independence in pediatric CP patients.
Abstract:
The purpose of this study is to determine if children more severely involved with cerebral palsy respond as well to rectus transfer and hamstring surgery as those with less severe involvement. Ninety-nine children were classified as independent community ambulators, crutch/walker-dependent community ambulators, or household/exercise ambulators. Maximum knee extension in stance and total range of knee motion in gait increased following surgery in all groups. Peak knee flexion in swing was maintained in the independent group only, but timing of knee flexion in swing improved in all groups. All groups showed increases in stride length, and the household/exercise group also showed an increase in walking speed. Four of 39 crutch/walker-dependent community ambulators and 13 of 21 household/exercise ambulators progressed to the next higher functional ambulation group.