Combined hamstrings lengthening and patellar tendon retensioning for neurogenic knee flexion in spastic diplegia

This study evaluates the effectiveness of combining hamstrings lengthening with patellar tendon retensioning to address neurogenic knee flexion deformity in children with spastic diplegia.

Sixty-eight patients with spastic diplegia (mean age: 10.7 years) underwent the combined surgical approach. Knee kinematic parameters, including knee flexion at initial contact (KIC), midstance (KmSt), swing phase (KMSw), and total range of motion (K-ROM), were analyzed preoperatively and at a 24-month follow-up. Outcomes were compared to a healthy control group (n = 20). Postoperative complications and recurrence rates were documented.

KIC and KmSt postoperatively noted significant improvements postoperatively, indicating enhanced postural control and reduced excessive knee flexion during stance. K-ROM also improved but remained below normative values. KMSw showed minimal improvement. Complications included wound dehiscence (11.8%) and loss of correction due to growth (14.7%). Despite these limitations, most patients achieved improved functional mobility and stability.

Combining medial flexor lengthening with patellar tendon retensioning is an effective surgical intervention for neurogenic knee flexion deformity in spastic diplegia. It reduces knee flexion deformity, enhances mobility, and potentially minimizes the need for additional procedures. However, growth-related correction loss underscores the importance of long-term monitoring. This approach offers a balanced solution to reducing flexor contractures and extensor deficits, ensuring better functional outcomes. Further studies with extended follow-ups are needed to confirm the sustainability of these results.