Abstract
Children with spastic diplegic and hemiplegic cerebral palsy frequently ambulate with flexed knee gait. There has been concern that hamstring lengthening used to treat this problem may weaken hip extension. This study evaluates the primary outcome of hamstring transfer plus lengthening in comparison with traditional hamstring lengthening in treating flexed knee gait in ambulatory patients with cerebral palsy. A total of 47 children (67 lower limbs) ranging in age from 5 to 17years old were included in this study. All subjects underwent a variety of additional surgeries at the time of the hamstring surgery as part of a multilevel treatment plan. All patients who met the inclusion criteria were divided into two groups, the hamstring lengthening alone group (HSL) and the hamstring transfer plus lengthening group (HST). Full gait analysis studies were done for all subjects pre-operatively and 1year post-operatively. There were 25 patients (35 limbs) in the HSL group and 22 patients (32 limbs) in the HST group. There was no significant difference in age, gender, or the time from surgery to post-operative gait analysis between groups. On physical examination, both HSL and HST groups showed improvement in passive knee extension, popliteal angle, and straight leg raise. Maximum knee extension in stance phase was improved in both groups. The maximum hip extension in late stance phase was significantly improved only in the HST group. The peak hip extension power in stance phase showed significant improvement only in the HST group and a significant decrease for the HSL group. The findings of this study demonstrated that both the HSL and HST procedures resulted in similar amounts of improvement in passive range of motion of the knee, as well in knee extension in stance during gait at 1year post-operatively. However, with the HST procedure, there was better preservation of hip extension power and improved hip extension in stance. The HST procedure should be considered when hamstring surgery is performed.
Highlights
Ambulatory children with spastic cerebral palsy frequently develop excessive knee flexion during the stance phase of gait [1]
This study evaluates the primary outcome of hamstring transfer plus lengthening in comparison with traditional hamstring lengthening in treating flexed knee gait in ambulatory patients with cerebral palsy
All patients who met the inclusion criteria were divided into two groups, the hamstring lengthening alone group (HSL) and the hamstring transfer plus lengthening group (HST)
Summary
Ambulatory children with spastic cerebral palsy frequently develop excessive knee flexion during the stance phase of gait [1]. In spastic diplegia, this can manifest as crouch gait, jump gait, or a mixed pattern [2]. This can manifest as crouch gait, jump gait, or a mixed pattern [2] In hemiplegia, this can present as knee flexion with apparent or true equinus [3]. The primary factor is dysphasic and excessive activity of the hamstrings, which tends to get progressively worse with time and is detrimental to the patient, as it requires increased work by the quadriceps to prevent the knee from collapsing. The hamstrings contribute to hip extension power, which is
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