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Distal hamstring lengthening in ambulatory children with cerebral palsy: primary versus revision procedures
Wei-Ning Chang1, Athanasios I Tsirikos, Freeman Miller
1Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
Insights
Distal hamstring lengthening (HL) in children with cerebral palsy improved knee contractures and gait. However, it decreased hip power and increased pelvic tilt, indicating HL is not solely indicated by popliteal angle increases.
Area of Science:
- Orthopedics
- Pediatric Rehabilitation
- Biomechanical Engineering
Background:
- Cerebral palsy (CP) often involves hamstring contractures, impacting gait and mobility.
- Distal hamstring lengthening (HL) is a surgical intervention to address these contractures.
Purpose of the Study:
- To evaluate the benefits and limitations of distal hamstring lengthening (HL) in children with cerebral palsy.
- To determine appropriate indications for repeated HL procedures.
Main Methods:
- Retrospective review of 61 children (105 limbs) with CP undergoing distal HL.
- Preoperative and postoperative gait analysis, including popliteal angle, knee flexion contracture, and pelvic tilt.
Main Results:
- Significant improvements observed in popliteal angle, fixed knee flexion contracture, knee angle at foot contact, and mid-stance knee extension.
- Decreased hip power generation peak and increased anterior pelvic tilt were noted.
- Repeated HL improved fixed knee flexion contracture and knee flexion at foot contact.
- Popliteal angle increased over time post-surgery without other gait changes.
Conclusions:
- Distal HL offers benefits for knee contractures and gait in CP but has limitations including reduced hip power and increased pelvic tilt.
- Indications for repeated HL should focus on fixed knee flexion contracture and increased knee flexion at foot contact, not solely on popliteal angle increase.
Abstract:
To document the benefits and limitations of distal hamstring lengthening (HL), 61 children (105 limbs) with cerebral palsy treated by distal HL with complete preoperative and postoperative evaluations were reviewed. There was significant improvement in popliteal angle, fixed knee flexion contracture, knee angle at foot contact (FC), and mid-stance knee extension after HL. On the other hand, the hip power generation peak decreased, and the anterior pelvic tilt increased. For the repeated HL (22 limbs), the fixed knee flexion contracture and knee flexion at FC improved. In a group of ten patients (17 limbs) with further postoperative follow up evaluations, the only significant clinical finding related to hamstring function between the first postoperative and the follow up evaluations with no intervening surgery was an increase in the popliteal angle of 20 degrees. Because the popliteal angle may increase over time after HL with no other directly related gait changes, the indications for repeated HL should include fixed knee flexion contracture and increased knee flexion at FC. The increase in the popliteal angle alone should not be considered an indication for repeated HL.