Repeat hamstring lengthening for crouch gait in children with cerebral palsy

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Gait analysis

Background:

• Progressive crouch gait is common in children with cerebral palsy (CP).
• Hamstring lengthening can correct crouch gait, but recurrences are possible.
• The effectiveness of revision hamstring lengthening versus primary surgery for recurrent crouch gait is unclear.

Purpose of the Study:

• To compare the effectiveness of revision hamstring lengthening (rHSL) versus primary hamstring lengthening (HSL) in improving crouch gait in patients with cerebral palsy.
• To evaluate the long-term outcomes of surgical interventions for recurrent hamstring contractures.

Main Methods:

• Retrospective review of 39 patients with cerebral palsy who underwent hamstring lengthening.
• Patients were divided into a primary HSL group (n=21) and a revision rHSL group (n=18).
• Comparison of pre- and postoperative range of motion and kinematic gait analysis data.

Main Results:

• Primary HSL significantly improved knee extension, popliteal angle, and hip/knee ROM compared to rHSL.
• 71% of patients in the HSL group improved stance knee extension by ≥10 degrees, versus 28% in the rHSL group.
• Improvements in the HSL group persisted after adjusting for preoperative differences.

Conclusions:

• Revision hamstring lengthening may temporarily delay progressive crouch gait but does not offer long-term correction.
• Recurrent crouch gait may be influenced by factors beyond hamstring contracture, such as quadriceps insufficiency.
• Alternative surgical interventions may be more beneficial for patients with recurrent crouch gait after initial hamstring lengthening.