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Updated: Aug 6, 2026
Enhancing the Development and Growth of Infant Cerebral Palsy Rats Using Selective Spinal Manipulations
Published on: February 2, 2024
Percutaneous tendon lengthening and selective percutaneous myofascial lengthening in children with cerebral palsy:
Michael Wade Shrader1, Benjamin J Shore2, Henry G Chambers3
1Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE, USA.
Insights
Percutaneous tendon lengthening (PTL) for cerebral palsy (CP) equinus is debated. Experts advise avoiding percutaneous plantar flexor lengthening due to overlengthening risks, urging more research on PTL and SPML safety and efficacy.
Area of Science:
- Orthopaedic surgery
- Pediatric orthopaedics
- Cerebral palsy management
Background:
- Percutaneous tendon lengthening (PTL) is a minimally invasive technique used in cerebral palsy (CP) management.
- While advocated for reduced pain and faster recovery, evidence supporting PTL and selective percutaneous myofascial lengthening (SPML) is limited.
- Expert consensus is needed to guide surgical indications for PTL and SPML in CP.
Purpose of the Study:
- To establish expert consensus on the surgical indications for PTL and SPML in children with CP.
- To address the limited evidence base for percutaneous tendon lengthening techniques in CP.
Main Methods:
- A 16-member panel of experts in CP surgical management participated.
- The modified Delphi method with a five-level Likert scale was employed to reach consensus.
- Consensus was defined as 80% agreement; general agreement was 60%-79%.
Main Results:
- Consensus was achieved on 22 out of 32 surveyed statements (69%).
- The panel reached consensus that percutaneous plantar flexor lengthening (PFL) for equinus in CP should be avoided due to overlengthening risks.
- Disagreement persisted on 10 statements (31%), particularly regarding the comparative evidence for PTL versus SPML.
Conclusions:
- Expert consensus indicates a need for more evidence on the safety and efficacy of percutaneous techniques across different anatomical areas in CP.
- Percutaneous plantar flexor lengthening for equinus in CP is strongly advised against due to the high risk of adverse outcomes.
- In the absence of high-quality prospective data, expert opinion provides crucial guidance for surgical decisions in CP management.
Purpose:
Percutaneous tendon lengthening (PTL), including selective percutaneous myofascial lengthening (SPML), is popular in cerebral palsy (CP) with advocates arguing that it is minimally invasive and may result in less pain and faster rehabilitation than open techniques, but supporting evidence is limited. The purpose of this study was to develop consensus for the surgical indications of PTL and SPML in CP.
Methods:
A 16-member panel, established experts with at least 10 years' experience in the surgical management of CP, was created to determine opinion consensus on orthopaedic surgical indications. The modified Delphi method was used, utilising a five-level Likert scale. Consensus was defined at 80% of responses being in the highest or lowest two of the five Likert ratings. General agreement was defined as 60%-79%.
Results:
Thirty-two statements were surveyed; consensus or general achievement was achieved for 22 questions (69%). The panel reached consensus that percutaneous methods for plantar flexor lengthening (PFL) for equinus in CP should be avoided due to the risk of overlengthening. There was disagreement on 10 questions (31%), primarily on the need for more evidence of differences between PTL and SPML.
Conclusions:
Expert consensus suggests more evidence is needed to establish the safety and efficacy of all types of percutaneous techniques across anatomical levels but confirmed that all percutaneous PFL in CP should be avoided due to the consequences of overlengthening.
Significance Of Study:
In the absence of prospective high-quality evidence, consensus opinion helps guide surgical decision-making for children with CP.
Level Of Evidence:
Level IV.