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Selective percutaneous myofascial lengthening of the lower extremities in children with spastic cerebral palsy
Evanthia A Mitsiokapa1, Andreas F Mavrogenis, Helen Skouteli
1Department of Physical Medicine and Rehabilitation, Thriasio Hospital, 19018 Elefsina, Greece.
Insights
Selective percutaneous myofascial lengthening improved function in children with spastic cerebral palsy. This minimally invasive surgery led to significant gains in gross motor function and classification levels.
Area of Science:
- Orthopedic Surgery
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Children with spastic cerebral palsy often develop lower extremity deformities.
- Contractures can impede walking and sitting, necessitating surgical intervention.
Purpose of the Study:
- To evaluate the efficacy of selective percutaneous myofascial lengthening for hip adductor and hamstring contractures in spastic cerebral palsy.
- To assess the impact on gross motor ability and function.
Main Methods:
- 58 children with spastic cerebral palsy underwent selective percutaneous myofascial lengthening.
- Procedures targeted hip adductor and hamstring groups.
- Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM) were used for evaluation.
Main Results:
- Mean operative time was 14 minutes; same-day discharge was standard.
- No major complications like infection or nerve damage occurred.
- Significant improvements observed: 34 children improved one GMFCS level, 5 improved two levels; mean GMFM scores rose from 71.19 to 83.19.
Conclusions:
- Selective percutaneous myofascial lengthening is a safe and effective procedure for managing lower extremity contractures in spastic cerebral palsy.
- The surgery leads to substantial improvements in gross motor function and classification levels.
Abstract:
Children with spastic cerebral palsy commonly acquire lower extremity musculoskeletal deformities that at some point may need surgical correction. The authors present 58 children with spastic cerebral palsy who underwent selective percutaneous myofascial lengthening of the hip adductor group and the medial or the lateral hamstrings. All the patients were spastic diplegic, hemiplegic, or quadriplegic. The indications for surgery were a primary contracture that interfered with the patients' walking or sitting ability or joint subluxation. Gross motor ability and gross motor function of the children were evaluated using the gross motor function classification system (GMFCS) and the gross motor function measure (GMFM), respectively. The mean time of the surgical procedure was 14 minutes (range, 1 to 27 minutes). All patients were discharged from the hospital setting the same day after the operation. There were no infections, overlengthening, nerve palsies, or vascular complications. Three patients required repeat procedures for relapsed hamstring and adductor contractures at 8, 14, and 16 months postoperatively. At 2 years after the initial operation, all the children improved on their previous functional level; 34 children improved by one GMFCS level, and 5 children improved by two GMFCS levels. The overall improvement in mean GMFM scores was from 71.19 to 83.19.
