[Percutaneous tenotomy and aponeurotomy (PTA) for knee flexor contracture in children with spastic cerebral palsy]

Knee flexor muscle contracture is frequent in patients with spastic cerebral palsy. The purpose of the study was to determine whether percutaneous tenotomy and aponeurotomy may decrease knee flexor contracture in children with spastic cerebral palsy.

A prospective study of consecutive cases was conducted from January to December 2009 in 24 children with a diagnosis of moderate to severe spastic cerebral palsy who had knee flexor contracture with a popliteal angle > or = 45 degrees and a gross motor function classification scale of 4 or 5; they underwent percutaneous tenotomy and aponeurotomy surgery and were followed-up for 24 months. Variance analysis with a factorial design was used for data analysis.

The mean popliteal angle was 83.48 degrees preoperatively and 27.30 degrees by the end of the follow-up, with an improvement of 56.18 degrees (p < 0.01). Statistically significant differences were found in all measurements comparing them with the baseline values.

Percutaneous aponeurotomy of knee flexor muscles is described. Compared to other procedures it provides the benefits of minimally invasive surgery, mild postoperative pain, short hospital stay -without using immobilization during the entire process- and children returned to their therapy program within five days.

Percutaneous tenotomy and aponeurotomy of knee flexors was shown to be a good alternative for the treatment of knee flexor contracture in patients with spastic cerebral palsy.