Abstract
The purpose of this study is to analyze the effect of distal release of the medial hamstrings on the gait of patients who had spastic cerebral palsy. Twenty-two patients had preoperative and postoperative gait analysis. Standard parameters, such as cadence, velocity, and stride length, were evaluated, as were sagittal plane motion graphs of the pelvis, hip, knee, and ankle, in addition to sagittal plane kinetic analysis. Extension of the knee in stance phase significantly improved postoperatively (p < 0.002), and the improvement was accompanied by a proportional decrease in knee flexion during swing with minimal net gain in the arc of knee motion. Knee range of motion could be improved more by concomitant rectus transfer in selected patients. The statistically significant increase in anterior pelvic tilt (p < 0.002) has been a main concern. There was no significant change in the hip extensor moments or power generation during stance. Increased knee extension during stance after distal release of medial hamstrings is the kinematic gain that improved the gait pattern in cerebral palsy patients. The authors recommend a concomitant rectus transfer to help improve the knee range of motion in patients with rectus over-firing during swing, hence avoiding a stiff knee gait.
Highlights
Spasticity of the hamstrings is a common problem in the management of patients who have cerebral palsy
It was found that the hamstring lengths during stance phase in most of patients with crouch gait were longer than the resting length and that hamstrings functioned as hip extensors during a significant portion of stance phase
Gait analysis documented that the main benefit was increased extension of the knee in the stance phase of gait
Summary
Spasticity of the hamstrings is a common problem in the management of patients who have cerebral palsy. A flexed knee needs greater muscular power to prevent the patient from collapsing, and this flexion may lead to compensatory flexion of the hip and equinus of the ankle when the tight gastrocnemius muscle is spastic. These factors lead to a gait pattern that is inefficient in terms of consumption of energy. Questions have been raised about the need for hamstring lengthening due to the possibility that it could aggravate crouch gait by increasing anterior pelvic tilt and weakening hip joint extension. Many authors have reported that hamstring lengthening is effective for treating knee flexion contracture and improving joint movement [2]
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