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Finding consensus for hamstring surgery in ambulatory children with cerebral palsy using the Delphi method.

Robert M Kay1, James McCarthy2, Unni Narayanan3

  • 1Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.

Journal of Children'S Orthopaedics
|May 26, 2022
PubMed
Summary

An expert panel established consensus on hamstring surgery indications for children with cerebral palsy. This aims to reduce practice variation and improve outcomes for ambulatory children undergoing these procedures.

Keywords:
Cerebral palsyconsensuscrouchhamstringsurgical indications

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Area of Science:

  • Pediatric Orthopedics
  • Cerebral Palsy Research
  • Surgical Consensus

Background:

  • Significant variation exists in hamstring surgery indications and techniques for pediatric cerebral palsy patients.
  • Uncertainty prevails regarding hamstring transfer versus traditional hamstring lengthening procedures.

Purpose of the Study:

  • To establish consensus on indications for hamstring surgery in ambulatory children with cerebral palsy using the Delphi method.
  • To provide expert guidance for optimizing surgical decision-making.

Main Methods:

  • An international expert panel utilized a five-level Likert scale to assess agreement on hamstring surgery aspects.
  • Consensus was defined as ≥80% agreement; general agreement as 60%-79%.

Main Results:

  • Consensus or general agreement was reached on 84% of statements regarding hamstring surgery.
  • Key findings include the importance of assessing pelvic tilt and that lateral hamstring lengthening is rarely indicated.
  • Repeat hamstring lengthening often yields poor outcomes, and the panel showed division on hamstring transfer indications.

Conclusions:

  • The study provides crucial insights for pediatric orthopedic surgeons to optimize hamstring surgery decisions in ambulatory cerebral palsy patients.
  • Implementing these consensus guidelines can reduce practice variation and enhance patient outcomes.