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Published on: May 20, 2019
Changes to medial gastrocnemius architecture after surgical intervention in spastic diplegia
Adam P Shortland1, Nicola R Fry, Linda C Eve
1One Small Step Gait Laboratory, Guy's Hospital, St Thomas Street, London SE1 9RT, UK. adam.shortland@gstt.sthames.nhs.uk
Insights
Gastrocnemius recession surgery in children with spastic diplegia shortens muscle fascicles and increases fascicular-aponeurosis angles. This alters muscle architecture, potentially improving walking by normalizing ankle position rather than enhancing gastrocnemius performance.
Area of Science:
- Biomedical Engineering
- Orthopedic Surgery
- Pediatric Rehabilitation
Background:
- Spastic diplegia often affects gait due to altered muscle mechanics.
- Gastrocnemius muscle spasticity is a common contributor to gait abnormalities in children with spastic diplegia.
- Understanding the impact of surgical interventions on muscle architecture is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To evaluate the changes in medial gastrocnemius muscle architecture after gastrocnemius recession in children with spastic diplegia.
- To compare the muscle architecture of these patients with normally developing children.
- To investigate the relationship between architectural changes and functional improvements in walking.
Main Methods:
- Ultrasound imaging was used to assess medial gastrocnemius fascicle length and deep fascicular-aponeurosis angle in nine children with spastic diplegia before and after gastrocnemius recession.
- Measurements were compared to a control group of normally developing children.
- Functional ambulation status was documented before and after surgery.
Main Results:
- Gastrocnemius recession resulted in significantly shorter fascicles (p=0.00226) and increased deep fascicular-aponeurosis angles (p=0.0152) in children with spastic diplegia.
- Pre-surgery fascicle lengths were comparable to controls, but post-surgery fascicles were shorter than in normally developing peers (p=0.00109).
- The degree of fascicular shortening varied among participants.
Conclusions:
- Gastrocnemius recession significantly alters the muscle architecture of the medial gastrocnemius in children with spastic diplegia.
- Observed improvements in ankle-joint power during walking post-surgery may be attributed to a more normalized ankle position.
- Further research is needed to fully elucidate the mechanical implications of these architectural changes on active muscle performance.
Abstract:
We assessed the architecture of the medial gastrocnemius in nine children (five males, four females; age range 6 to 15 years; mean 10 years 10 months, SD 3 years 6 months) with spastic diplegia by ultrasound imaging before and after a gastrocnemius recession. The children were ambulant (seven independent, one with a posterior walker, one using crutches) before and after surgical intervention. We compared values for fascicle lengths and deep fascicular-aponeurosis angles with those from a group of normally developing children (five males, five females; age range 6 to 11 years; mean 8 years 4 months, SD 1 year 4 months). Despite a variable interval between assessments (from 56 to 610 days), fascicles were shorter (p=0.00226) and the deep fascicular-aponeurosis angle increased (p=0.0152) after intervention. Fascicle lengths of patients were similar to those in the group of normally developing children before surgery. After surgery, fascicles in the group of children with spastic diplegia were shorter than in their normally developing peers (p=0.00109). The gastrocnemius recession procedure alters muscle architecture, though the degree of fascicular shortening varied, with four of the participants in our study losing less than 10% of their original fascicular length at maximum dorsiflexion. Increases in ankle-joint power in walking, observed after surgical intervention in children with spastic diplegia, may be due to a more normal ankle position rather than to improvements in the active mechanical performance of the gastrocnemius.
