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Percutaneous Hamstring Lengthening Surgery is as Effective as Open Lengthening in Children With Cerebral Palsy

Alexander Nazareth1, Susan Rethlefsen2, Ted C Sousa2

  • 1Keck School of Medicine.

Journal of Pediatric Orthopedics
|July 16, 2019
PubMed

Insights

Percutaneous hamstring lengthening (pHSL) is as effective as open hamstring lengthening (oHSL) for improving crouch gait in children with cerebral palsy. Both procedures enhance knee extension, with pHSL offering potential advantages in rehabilitation.

Area of Science:

  • Orthopedics
  • Pediatric Surgery
  • Biomechanical Engineering

Background:

  • Crouch gait in children with cerebral palsy (CP) is often treated with hamstring lengthening surgery.
  • Open hamstring lengthening (oHSL) is established, but data on percutaneous hamstring lengthening (pHSL) is limited.
  • This study compares the efficacy of oHSL versus pHSL in improving gait and knee function in pediatric CP patients.

Purpose of the Study:

  • To investigate the effect of open versus percutaneous hamstring lengthening on crouch gait and knee function in children with CP.
  • To compare the kinematic outcomes of oHSL and pHSL in this population.

Main Methods:

  • Retrospective cohort study of 87 ambulatory children with CP undergoing hamstring lengthening.
  • Comparison of preoperative and postoperative 3D kinematic gait analysis data.
  • Statistical analysis including t tests, chi-square tests, and multiple regression.

Main Results:

  • Both oHSL and pHSL significantly decreased knee flexion at initial contact and increased maximum knee extension during stance.
  • No significant differences in kinematic improvements were found between the oHSL and pHSL groups after covariate adjustment.
  • Postoperative static range of motion changes were similar for both surgical techniques.

Conclusions:

  • Percutaneous hamstring lengthening (pHSL) demonstrates comparable effectiveness to open hamstring lengthening (oHSL) in improving stance phase knee kinematics for children with CP.
  • This study is the first to compare the kinematic effects of open versus pHSL in pediatric CP.
  • pHSL is well-tolerated and may be preferred due to faster rehabilitation potential.
Abstract

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