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Updated: Jun 15, 2026
Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis
Published on: March 23, 2019
Static and dynamic gait parameters before and after multilevel soft tissue surgery in ambulating children with
Nicholas M Bernthal1, Seth C Gamradt, Robert M Kay
1University of California Los Angeles Medical Center, Los Angeles, CA 90921, USA. nbernthal@mednet.ucla.edu
Insights
Soft tissue surgery improves static contractures and knee function in children with cerebral palsy (CP). However, caution is advised with heel cord lengthening due to potential calcaneal gait and limited hip improvements.
Area of Science:
- Orthopedic Surgery
- Pediatric Rehabilitation
- Biomechanical Analysis
Background:
- Studies question the effectiveness of releasing hip flexion contractures and subsequent ankle position after tendoachilles lengthening in ambulatory children with cerebral palsy (CP).
- Cerebral palsy often involves motor impairments affecting gait and lower limb positioning.
Purpose of the Study:
- To evaluate the clinical and gait outcomes of soft tissue lengthening procedures in ambulatory children with CP.
- To assess the impact of these procedures on hip, knee, and ankle kinematics and temporal-spatial gait parameters.
Main Methods:
- Retrospective review of clinical and computerized gait data from 23 ambulatory children with CP who underwent 96 soft tissue-lengthening procedures.
- Procedures excluded bony surgery; preoperative and postoperative data were analyzed.
Main Results:
- Significant improvements were observed in static contractures, including hip flexion, hip abduction, popliteal angle, and ankle dorsiflexion.
- Knee kinematics showed notable benefits, with improved maximal knee extension during stance and initial contact.
- Hip and pelvic motion showed minimal significant changes; ankle data indicated a tendency toward calcaneal gait post-Achilles lengthening.
Conclusions:
- Soft tissue surgery reliably improves static contractures and knee kinematics in children with CP.
- The persistence of crouch gait, potentially due to lever arm dysfunction in cases without bony surgery, may limit hip kinematic improvements.
- Heel cord lengthening should be approached with caution in this population due to potential adverse effects on ankle function.
Background:
Recent studies have questioned the efficacy of releasing hip flexion contractures and the resulting ankle position after tendoachilles lengthening in ambulating children with cerebral palsy (CP).
Methods:
Twenty-three ambulatory children with CP underwent 96 soft tissue-lengthening procedures without bony surgery. Preoperative and postoperative clinical and computerized gait data were reviewed.
Results:
Static contractures improved reliably, with improvements in all areas measured, including hip flexion contracture (14 degree improvement), hip abduction (19 degree improvement), popliteal angle (26 degree improvement), and ankle dorsiflexion (11 degree improvement). The changes in computerized gait data were less uniform. The knees showed significant benefits, as evidenced by improved maximal knee extension in stance phase (37.3 degree preop and 19.9 degree postop) and at initial contact (51.6 degree preop and 34.8 degree postop). At the hip, a statistically significant improvement was only seen in maximum hip extension in stance phase (minimum hip flexion), and the magnitude of this change was only 4.6 degree (15.3 to 10.7 degree). There were no significant changes at the pelvis. At the ankle, the tendency was toward calcaneal gait after Achilles tendon lengthening, with excessive dorsiflexion seen both in stance (17.3 degree) and at toe off (-6.9 degree). Tempero-spatial parameters showed improved stride length, but no significant changes in gait velocity or cadence.
Discussion:
The persistence of crouch postoperatively, though improved, likely limited the potential changes in hip kinematics. As this study excluded patients undergoing osseous surgery, it is possible that lever arm dysfunction may have contributed to the ongoing crouch. The results of this study suggest that static contractures and knee kinematics improve reliably after soft tissue surgery in children with CP, but that caution must be exercised when considering heel cord lengthening in these children.
Level Of Evidence:
Therapeutic level II. See Instructions to Authors for a complete description of levels of evidence.
