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(in vivo Gastrocnemius Muscle) Tendon Ratio in Patients with Cerebral Palsy
Muhammad Naghman Choudhry1, Haris Naseem1, Ihsan Mahmood2
1Royal Manchester Children's Hospital, Upper Brook Street, Manchester, M13 9WL, U.K.
Insights
Children with cerebral palsy (CP) have shorter gastrocnemius muscles. A new formula accurately locates the muscle-tendon junction for surgery, reducing incision length and iatrogenic injury risk.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Medical Imaging
Background:
- Gastrocnemius tendon length may differ in children with cerebral palsy (CP) compared to typically developing children.
- Current methods for locating the gastrocnemius tendon for surgery rely on palpation or surgeon experience, risking inaccurate incisions and iatrogenic damage.
- Accurate localization of the gastrocnemius tendon is crucial for safe and effective surgical lengthening procedures.
Purpose of the Study:
- To compare gastrocnemius muscle length in children with CP versus unaffected children.
- To develop a formula for precise localization of the gastrocnemius muscle-tendon junction in children with CP.
- To improve surgical outcomes by minimizing incision length and potential harm.
Main Methods:
- Ultrasound scanning was used to measure gastrocnemius muscle belly length in 10 children with hemiplegic CP (ages 2-14) and 10 age/sex-matched typically developing children.
- Measurements were taken at rest.
- Child heights and leg lengths were also recorded.
Main Results:
- Gastrocnemius medial muscles were found to be shorter in children with CP compared to controls.
- The ratio of gastrocnemius muscle length to leg length in children with CP ranged from 35% to 50%, with an average of 45%.
Conclusions:
- A novel average percentage for gastrocnemius muscle length has been established for clinical use.
- This percentage aids in accurately identifying the tendon for open or endoscopic lengthening procedures.
- The findings facilitate simple and accurate localization of the gastrocnemius muscle-tendon junction, reducing surgical incision size and the risk of iatrogenic injuries.
Background:
The position of the gastrocnemius tendon in relation to the leg length may be different in children with cerebral palsy as compared to normal children. The palpation of muscle bellies or previous experience of the operating surgeon is employed to place the surgical incision for lengthening of the gastrocnemius aponeurosis. Inaccurate localisation may cause incorrect incisions and a risk of iatrogenic damage to the vital structures (i.e. sural nerve).
Objectives:
The aim of our study is to compare gastrocnemius length in-vivo between paretic and unaffected children and create a formula to localise the muscle-tendon junction accurately.
Methods:
10 children with di/hemiplegia (range 2-14y) were recruited. None of them had received any conventional medical treatment. An equal number of age/sex matched, typically developing children (range 4-14y) were recruited. Ultrasound scanning of the gastrocnemius muscle at rest was performed to measure the length of gastrocnemius bellies. We also measured the heights and leg lengths in all the children.
Results:
The gastrocnemius medial muscles were shorter in Cerebral Palsy children when compared to similar aged normal children. In cerebral palsy children, the gastrocnemius muscle and leg ratio ranged between 35 to 50% (average ratio of 45%).
Conclusion:
Using these figures, we created an average percentage for gastrocnemius muscle length that may be used clinically to identify the tendon for open/endoscopic lengthening and also to make simple and accurate localisation of gastrocnemius muscle-tendon junction for surgical access. This decreases the length of the surgical incision and may reduce the risk of iatrogenic injuries.
