Does tendon lengthening surgery affect muscle tone in children with cerebral palsy?

Area of Science:

• Orthopedic Surgery
• Pediatric Neurology
• Rehabilitation Medicine

Background:

• Cerebral palsy (CP) often involves muscle spasticity, impacting mobility.
• Orthopedic surgery, such as tendon lengthening, is a common intervention for CP.
• Understanding the effect of surgery on dynamic muscle properties is crucial for treatment optimization.

Purpose of the Study:

• To evaluate the impact of surgical hamstring and gastrocnemius/Achilles complex lengthening on muscle tone in ambulatory children with CP.
• To assess changes in the dynamic component of muscle length following orthopedic surgery.

Main Methods:

• Retrospective study of 135 ambulatory children with CP undergoing hamstring or gastrocnemius/Achilles tendon lengthening.
• Measurements included popliteal angle and ankle dorsiflexion using a goniometer with quick and slow stretch.
• Spasticity assessed by the difference between quick and slow stretch (delta ml) and the modified Ashworth scale.

Main Results:

• Significant improvements in popliteal angle (18° EOR, 32° quick stretch) and ankle dorsiflexion (14° EOR, 18° quick stretch) were observed postoperatively.
• All measured parameters (slow stretch, quick stretch, delta ml) showed statistically significant changes (p < .0001 for most).
• Modified Ashworth scale scores reduced by at least one grade in 89% (hamstring) and 78% (triceps surae) of patients with preoperative scores of 3 or higher.

Conclusions:

• Surgical lengthening of the hamstrings and gastrocnemius/Achilles complex effectively reduces muscle tone and spasticity in children with cerebral palsy.
• The dynamic muscle length changes indicate a significant positive impact on joint range of motion and spasticity.
• These findings support the efficacy of these surgical interventions in improving motor function in pediatric CP patients.