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Functional changes in the antagonists after lengthening the agonists in cerebral palsy. I. Triceps surae lengthening
1Clinic for Cerebral Palsy and Orthopaedic Department, Rigshospitalet, University of Copenhagen, Denmark.
Insights
Surgery to lengthen tendons in children with spastic cerebral palsy improved dorsiflexor strength significantly. This procedure enhances antagonist muscle function by reducing spasticity in the agonist muscles.
Area of Science:
- Orthopedic Surgery
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Spastic cerebral palsy often impairs motor function, particularly in the lower extremities.
- Tendon contractures, especially in the gastrocnemius and tendo Achillis, are common in spastic cerebral palsy.
- Surgical interventions aim to improve muscle function and gait in affected children.
Purpose of the Study:
- To evaluate the functional outcomes of tendon lengthening surgery in children with spastic cerebral palsy.
- To assess the impact of reducing agonist spasticity on antagonist muscle strength and function.
- To determine the long-term effects of these surgical procedures on dorsiflexor strength.
Main Methods:
- A cohort of children with spastic cerebral palsy underwent 52 surgical procedures (tendo Achillis elongation or gastrocnemius aponeurotomy).
- Patients were assessed preoperatively and up to 14 months postoperatively.
- Muscle strength was quantified using a scale to measure the ability to lift weights, focusing on dorsiflexors.
Main Results:
- Postoperative dorsiflexor strength increased by over 50% by cast removal (4 weeks) and over 200% by 14 months.
- Preoperative and postoperative functional levels were correlated.
- No cases of excessive triceps lengthening were observed; however, two patients with initially absent dorsiflexor function lost gains due to dynamic shortening recurrence after one year.
Conclusions:
- Tendon lengthening surgery effectively improves dorsiflexor strength in children with spastic cerebral palsy.
- Reducing agonist spasticity through tendon lengthening positively impacts antagonist muscle function.
- While generally successful, long-term monitoring is necessary to address potential dynamic shortening recurrence.
Abstract:
In a recent study, children with spastic cerebral palsy (median age, five years) were examined before and up to a median of 14 months after 52 operations involving elongation of the tendo Achillis or aponeurotomy of the gastrocnemius. On removal of the cast four weeks postoperatively, strength in the dorsiflexors had increased by more than 50%, as evaluated by the ability to raise a weight from a scale. Postoperative function was correlated with preoperative function. Strength had increased more than 200% by 14 months postoperatively, with no instance of excessive lengthening of the triceps. In 13 cases, the dorsiflexors had been without function preoperatively. Two of those cases again lost the dorsiflexor function achieved postoperatively, when dynamic shortening recurred after one year. The study thus confirms the view that antagonist function improves when spasticity in the agonist is reduced by tendon lengthening.