Popliteal Angle Research Articles

Flexibility does not affect the dorsiflexion of foot and the popliteal angle in young adults

BackgroundThe aim of the study was to assess how flexibility affects the dorsiflexion of foot and the popliteal angle test results in junior high school students. MethodsThe subjects were 142 students from the 2nd, and 3rd year of Poznań junior high schools (age between 13 and 15).Each subject was examined 6 times: there were 3 raters, a specialist in orthopaedics, a resident doctor and a physical therapy student, and each of them performed 2 measurements. Flexibility was also measured using the Beighton scale (score from 0 to 9). ResultsSince the Beighton scale is ordinal in order to evaluate the relationship between flexibility and the range of motion Spearman's rank correlation coefficient was calculated. The statistical analysis showed no correlation between flexibility measured on the Beighton scale and the range of passive foot dorsiflexion and the popliteal angle. ConclusionsThe degree of flexibility does not affect the dorsiflexion of the foot and the popliteal angle in junior high students. At this age the range of dorsiflexion is determined by the length of the triceps surae muscle while the popliteal angle depends on the length of the muscles on the back of the thigh.

Improved Clinical and Functional Outcomes in Crouch Gait Following Minimally Invasive Hamstring Lengthening and Serial Casting in Children With Cerebral Palsy.

Serial extension casting represents a novel solution for addressing residual knee flexion contractures following hamstring lengthening in children with cerebral palsy. The purpose of this study was to investigate postoperative changes in patients following hamstring lengthening with a serial casting protocol. Measures from preoperative and postoperative gait analyses were reviewed retrospectively for 19 patients with cerebral palsy who underwent hamstring lengthening followed by serial extension casting. Postoperative changes in clinical, functional, and kinematic parameters were assessed using paired parametric methods. Improvements were measured in popliteal angle, knee contracture, peak stance phase knee extension, sagittal plane range of motion of the knee during walking, Gait Deviation Index, and pediatric outcomes data collection instrument Global score. Nearly 80% of the cohort (15/19 patients) demonstrated a significant or moderate response to the intervention, whereas 20% demonstrated no improvement. Of note, significantly increased anterior pelvic tilt was also observed. Hamstring lengthening combined with a serial casting protocol was associated with significant postoperative improvements in a range of clinical (eg, knee contracture), functional (eg, pediatric outcomes data collection instrument Global), and kinematic (eg, knee extension in stance) parameters. Improvements following this minimally invasive surgery were comparable to outcomes from procedures with higher complication rates. This is a Level III Therapeutic Study (retrospective study investigating the results of a treatment).

Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy

This study aims to evaluate the clinical outcomes of children with spastic type cerebral palsy (CP) treated with botulinum toxin type A (BoNT-A) injection for lower limb contracture and the influence of age, gender, functional level and degree of initial contracture on treatment outcomes. Clinical records at pre-BoNT-A injection and post-BoNT-A injections of 153 sessions of a total of 118 consecutive children (67 boys, 51 girls; mean age 5.9±2.6 years; range, 2.5-16 years) were retrospectively evaluated. Degrees of pre- and post-injection contracture were evaluated. Post-injection supplemental casting for 10 days was recorded in all cases. Less than 20° of hip flexion contracture, more than 30° of hip abduction, a negative prone Ely test, less than 50° of popliteal angle and at least 5° of ankle dorsiflexion values at post-injection were accepted as sufficient clinical improvement. Sufficient post-injection range of motion (ROM) was observed in 80% of cases with hip flexion contracture, in 45% of cases with hip adduction contracture, in 84% of cases with knee flexion contracture and in 77% of cases with ankle equinus contracture. Prone Ely test that was positive in 60% of cases with knee extension contracture was negative at post-injection. Improvement in contractures were prominent in children with lesser degree initial contractures. Botulinum toxin type A injection increases ROM in hip, knee and ankle joint contractures in CP. Although age, gender and functional level may influence the clinical outcomes, pre-treatment level of contracture is the main determinant in improvement in ROM at post-injection.

Passive range of motion changes in young children with spastic diplegia. A study during the initial stages of independent walking.

To investigate how the onset of independent walking in children with Cerebral Palsy (CP) influences the Passive Range of Motion (PROM) of lower limb joints. Sixteen children with CP, GMFCS levels I and II, and 16 Typical Development (TD) children who had just begun independent walking participated in the study. The PROM of the hip abduction and external rotation, knee extension, popliteal angle, and ankle dorsiflexion was recorded with a goniometer at the onset of independent walking and 8months later. A repeated-measures two-way ANOVA was conducted to compare the main effects of "walking experience" and "group of children" and the interaction effect between them on PROM of lower extremities' joints. The effect of "group of children" in the PROM was significant; differences were observed between children with CP and TD children for all joints (p< 0.05). The effect of "walking experience" did not have a significant impact on PROM changes and the interaction effect of "group of children" and "walking experience" was also not significant for all the variables. The alternative gait pattern spontaneously adopted by children with CP does not significantly impact their PROM during the initial stages of walking development. The lower PROM in highly functional children with CP compared to TD children cannot be attributed to gait initiation with an "atypical" pattern, but possibly to other factors such as reduced voluntary movement and age.

The popliteal angle tests in patients with cerebral palsy.

The aims were to determine during the popliteal angle (PA) tests whether particular knee muscles are activated and whether the position of pelvis affects the level of muscles activation. Twenty-two patients with cerebral palsy were recruited (age: 14±4.94 years). Knee muscle activities and range of motion were measured during PA. Knee flexors were active during tests, with fivefold increase of activation of ipsilateral hamstring. Higher and more frequent activation of muscles only in the contralateral limb was seen. Muscles activation should be considered as a confounding factor during tests. PA should not be relied upon as a major criterion for the treatment selection in cerebral palsy.

Hamstring lengthening in females with cerebral palsy have greater effect than in males.

Children with spastic diplegia cerebral palsy often demonstrate crouched gait patterns, and typically undergo hamstring lengthenings. The objective of this retrospective study was to determine if the surgical response to medial and lateral hamstring lengthenings is different between males and females. Preoperative and postoperative kinematic data of 109 (71 males and 38 females) patients with cerebral palsy were evaluated. Females demonstrated larger decreases in popliteal angle, larger decreases in mid-stance knee flexion, and higher incidences of knee hyperextension postoperatively. Results indicate that females have larger responses to hamstring lengthenings than males.

Percutaneous Versus Open Hamstring Lengthening in Spastic Diplegic Cerebral Palsy.

Open hamstring lengthening (oHSL) is commonly performed to decrease knee contracture and improve gait and posture for children with spastic diplegia. Furthermore, percutaneous hamstring lengthening (pHSL) is also gaining popularity as an alternative to the open approach. This study aimed to compare the results of pHSL versus oHSL and to determine the efficacy and safety of the percutaneous approach. This retrospective included 54 patients (108 knees) with spastic diplegia operated for flexed knee gait with either open or percutaneous HSL. The mean age of the participants at the time of surgery was 10.3±1.7 years (age range: 5-25 years) for the open and 8.5±1.5 years (age range: 7-23 years) for the percutaneous group. Overall, 29 and 25 children were subjected to oHSL and pHSL, respectively. The mean durations of follow-up were 19.1 months (range: 12-49 months) and 18.3 months (range: 14-45 months) for oHSL and pHSL groups, respectively. In the open group, the mean of preoperative popliteal angle decreased from 64.3±3.6 to 28.4±4.3 (P<0.001), and in the percutaneous group from 63.8±2.7 to 29.5±2.3 (P<0.001). The obtained results revealed no significant differences between the two approaches leading to a similar improvement among the investigated patients (P=0.83). Although the Gross Motor Function Class Score improved significantly within each group (P<0.001); this improvement was insignificant between the groups (P=0.88). The mean of hospital stay for the percutaneous group was 1.6 days (range:1-3 days) compared to 3.6 days (range: 2-6 days) for the open group, which indicated a significant difference (P=0.001). The mean values of total cost were $333 and $473 in the percutaneous group and open group (P=0.001), respectively. There was no significant difference between the groups regarding the complication rate (P=0.85). Percutaneous HSL is a safe, easy, rapid, and brief procedure that is as effective as the open technique for children with spastic diplegia in a short period of time. However, it is essential to examine the effects of this approach during longer follow-ups to generalize the findings of the current study.

Botulinum toxin treatment in children with cerebral palsy

Introduction: Botulinum toxin is used for decreasing spasticity, improving gait pattern and preventing secondary deformities and orthopedic surgeries in children with cerebral palsy. Despite its wide use, there is no evidence for the long-term beneficial effect of the toxin. Aim: The authors focused on the short-term effects of the toxin and on the subjective evaluation done by the parents about the botox treatment. Method: First, the calf muscle of 18 children was treated and casting was also performed. In our second patient group, multilevel lower limb injection was done in 12 cases. Joints' range of motion, muscle tone and spasticity were assessed before and 4-6 weeks after treatment. In ambulatory children, gait analysis was done. Side effects were recorded and parental opinion about the treatment was requested. Results: Increased ankle range of motion and decreased muscle tone and spasticity were seen in our first patient group. In the second group, hip flexion contracture became milder and hip abduction and the popliteal angle improved. However, gait analysis results only slightly changed after botox treatment. Occasional mild and transient adverse effects were observed during the pharmacologically active period of the toxin. Associate beneficial effects were also reported such as better comfort, easier movements, improving function of the non-injected upper limb, decreasing dysarthria and dysphagia. Conclusion: Our study strengthens the observation that botox treatment of the spastic calf muscle together with plaster casting can result in improved ankle dorsiflexion. Multilevel botox treatment can improve lower limb joints range of motion, however, gait pattern remains unchanged. The administration of botulinum toxin with respect to the guidelines has no major adverse effects. Further studies are needed to clarify the observed beneficial associate effects of the toxin. Orv Hetil. 2019; 160(28): 1105-1111.

Stretching and Progressive Resistance Exercise in Children With Cerebral Palsy: A Randomized Controlled Trial.

To evaluate the effect of stretching and progressive resistance exercise on range of motion and muscle strength in children with cerebral palsy. Thirty-seven children with spastic bilateral cerebral palsy and Gross Motor Function Classification System levels I to III were randomized to an intervention and a comparison group. The intervention included stretching of hamstrings and progressive resistance exercise, targeting the lower extremities for 16 weeks, followed by a 16-week maintenance program. Passive and active popliteal angle and muscle strength were evaluated at 0, 16, and 32 weeks. After 16 weeks nonsignificant improvements were found in passive, active popliteal angle and quadriceps and hamstrings strength. A 16-week stretching and progressive resistance exercise program followed by a 16-week maintenance program showed nonsignificant improvements in passive, active popliteal angle and muscle strength for the intervention group.

Reliability of Inclinometer-Derived Passive Range of Motion Measures in Youth with Cerebral Palsy

Aims: This study evaluated, for youth with cerebral palsy (CP), the reliability of passive range of motion (PROM) measures taken with an inclinometer, a device that may be simpler to use than a goniometer. Methods: The PROM for elbow and wrist extension, ankle dorsal flexion (knee flexed 90° and fully extended), and the knee popliteal angle of 30 youth with CP (18 boys, 12 girls, 7.0 ± 3.8 years old, classified in Gross Motor Function Classification levels I–V) was measured using an inclinometer. Two physical therapists took the measures during two different sessions, a maximum of 1 week apart. Results: Good mean intra-rater inter-session, inter-rater intra-session, and inter-rater inter-session reliability (ICC = 0.75–0.89), was found for the elbow, ankle, and knee sites. Absolute reliability for these sites and conditions was 7–14° (90% confident) and 10–16° (95% confident). Reliability values for wrist extension were comparable, albeit slight lower. Conclusions: Similar to published values for goniometry, inclinometery yields reliable upper and lower limb PROM measures from ambulatory and non-ambulatory youth with CP whether measures are carried out by different evaluators within or across sessions or whether measures are performed by the same evaluator across sessions.

Quantitative Assessment of Muscle Strength Following "Slow" Surgical Lengthening of the Medial Hamstring Muscles in Children With Cerebral Palsy.

Classic teaching for surgical lengthening of muscle contractures in children with cerebral palsy (CP) has emphasized complete correction of the deformity acutely, with immobilization of the targeted muscles in the fully corrected position. Clinical experience has led to the impression that the muscles are invariably weakened by this approach. We have developed an alternative technique for correction of contractures called slow surgical lengthening (SSL). The goal of the study was to determine the physical examination, kinematic, and muscle strength outcomes following SSL of the medial hamstring muscles in children with CP. The study group included 41 children with CP who underwent SSL of the medial hamstring muscles as part of a comprehensive single-event multilevel surgery, who had preoperative and 1-year postoperative evaluations in our Motion Analysis Center, which included quantitative assessment of isometric and isokinetic muscle strength. All subjects were Gross Motor Function Classification System I and II. Mean age at the time of surgery was 10.8 years. The mean popliteal angle improved by 16.2 degrees (P<0.001) following SSL of the medial hamstrings. Sagittal plane kinematics following SSL of the medial hamstrings showed improvement of knee extension at initial contact of 10.2 degrees (P<0.001), decrease of peak knee flexion in mid-swing of 3.6 degrees (P=0.014), improved minimum knee flexion in stance of 4.9 degrees (P=0.002), and no significant change in mean anterior pelvic tilt (P=0.123). Mean peak isometric knee flexion torque remained unchanged from preoperative to postoperative studies (P=0.154), whereas mean peak isokinetic knee flexion torque significantly increased by 0.076 Nm/kg (P=0.014) following medial hamstring SSL. SSL was developed based upon clinical experience and improved understanding of the pathophysiology of skeletal muscle in children with CP. The SSL technique allows the tendinous tissue to separate spontaneously at the time of recession, but does not force further acute lengthening by intraoperative manipulation, thereby minimizing the damage to the underlying muscle. It is broadly believed that muscle weakness is inevitable following surgical lengthening. The current study shows that the SSL technique does not cause weakness. Level IV-therapeutic.

Effects of moving cupping therapy on hip and knee range of movement and knee flexion power: a preliminary investigation

ABSTRACTCupping therapy has become more popular in the sports setting because of its simplicity in application, minimal adverse effects, and reduction in pain and muscle tenderness, yet there is little research on its effectiveness for range of movement and power.Objectives: The primary aim of this study was to investigate if a single session of moving cupping to the posterior aspect of the lower limb effects hip and knee range of movement and knee flexion power. The secondary aim was to consider participants’ views and perceptions of moving cupping therapy.Methods: Twenty-one healthy participants (12 male and 9 female) aged between 19 and 31 years volunteered to take part in the study. All participants received 15 min of moving cupping therapy to their dominant posterior lower extremity. Hip and knee range of movement and knee flexion isokinetic power measurements were taken prior to and immediately after the moving cupping intervention. Participants also completed a questionnaire based on their experience and perceptions of cupping.Results: Results showed a significant increase (p = <.05) in hip and knee range of movement measurements by 7% in the straight leg raise and 4% in a popliteal angle test. However, no significant changes were seen in the knee flexion power measures. Data from the questionnaire suggest that despite moving cupping being reported as ‘uncomfortable’ it is considered acceptable.Discussion: Moving cupping therapy may have short-term changes to range of movement but not power, though the limitations of this study mean that rigorous studies are required before the effectiveness of moving cupping can be determined.

Outcome of intensive rehabilitation following single-event multilevel surgery for crouch gait in children with cerebral palsy

BackgroundCrouch gait is one of the most common gait patterns in ambulatory children with cerebral palsy (CP) and is contributed by several factors. The literature reports wide variations in surgical practice and rehabilitation programs following single-event multilevel surgeries.ObjectiveTo evaluate the outcome of rehabilitation after single-event multilevel orthopedic surgery for crouch gait in children with CP.Patients and methodsA total of 20 children with bilateral spastic CP and walked with a crouch gait, with gross motor function classification system levels II, III, and IV, were subjected to single-event multilevel surgery. Ten (20 limbs) patients were men and eight (14 limbs) were women. Their age ranged from 5.5 to 19 years. To assess the outcome of our rehabilitation program, we used clinical couch examination parameters, functional mobility scale, and instrumented three-dimensional gait analysis. Rehabilitation program included preoperative and postoperative rehabilitation at 1-year postoperatively.ResultsHighly statistically significant improvements in clinical parameters, which include hip abduction, femoral anteversion, fixed flexion deformity, popliteal angle, and extension lag, were demonstrated (P<0.01), whereas tibial torsion showed a statistically significant improvement (P<0.05). Functional mobility scale at 5, 50, and 500m improved in 10 (55.6%) cases, 13 (72.2%) cases, and 11 (61.1%) cases, respectively. Instrumented gait laboratory parameters, namely, stride length, crouch angle at initial stance, and peak knee flexion in mid-swing, showed improvement but did not reach statistical significance.ConclusionThe rehabilitation program we offered improves clinical and functional mobility of children with CP with crouch gait. Thus, it is viewed as an important contributor to the overall outcome together with multilevel orthopedic surgery.

The effects of yoga practice on balance, strength, coordination and flexibility in healthy children aged 10–12 years

ObjectiveThe purpose of this study was to investigate the effects of yoga practice on balance, strength, coordination, and flexibility in healthy children aged 10–12 years. Study designQuasi-experimental, nonrandomized. BackgroundResearch on the effects of yoga in children has focused on the benefits seen in non-healthy children or on the effects on hand grip strength and motor performance. The studies on the effects of yoga on balance, strength, coordination, and flexibility have been limited. Methods and MeasuresA convenience sample of 26 children, aged 10–12 years was obtained. The children participated in 40 min yoga sessions, led by a registered yoga teacher, 1–3 times per week for 8 weeks. The Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2), the sit and reach test, and the 90/90 hamstring flexibility test were administered at baseline and at the end of the 8 weeks. Descriptive statistics were calculated for all measurements. A Shapiro-Wilk test was used to test normality. A Wilcoxin signed-rank test was used to analyze pre- and post-test measurements for all variables. ResultsThere was a statistically significant within-subject difference from pre-test to post-test for balance (p = 0.026), sit and reach (p = 0.000), popliteal angle right (p = 0.005), and popliteal angle left (p = 0.018). There were no statistically significant differences in strength and bilateral coordination from pre-to post-test measurements. ConclusionsYoga may be a beneficial form of exercise in the school-based setting for improving balance and flexibility in healthy children.

Effect of retro-walking on treadmill on hamstring flexibility, gait, kinesiophobia, and psychometry in individuals with chronic knee osteoarthritis

Background and Objective: The purpose of the study was to evaluate and compare the immediate- and short-term (five sessions) effects of retro-walking (RW) on treadmill along with conventional treatment and conventional treatment alone on hamstring flexibility, gait velocity, cadence, kinesiophobia, and psychometry in individuals with chronic knee osteoarthritis (OA).Materials and Methods: The present study was a randomized controlled trial. Twenty-eight individuals clinically diagnosed with Grade 2 or 3 knee OA between the age group of 40 and 70 years participated in the study. The individuals were randomly allocated to two study groups. Control group received conventional treatment of transcutaneous electrical nerve stimulation (TENS) and exercises, whereas experimental group received RW on treadmill along with TENS and exercises for five sessions. Outcome measures were assessed using popliteal angle measurement, walking velocity, cadence, Tampa Scale for Kinesiophobia 11, and Self-efficacy for Managing Chronic Disease 6-item scale.Results: Between-group analysis showed that RW was superior to control group (P < 0.005) in terms of improvement in walking velocity, cadence, and reduction in kinesiophobia in individuals with chronic knee OA. However, immediate effect was statistically significantly better in RW group only in terms of walking velocity (P < 0.005).Conclusion: The RW group demonstrated to be more effective than conventional physiotherapy group on walking velocity, cadence, and kinesiophobia. Hence, RW may be considered as part of the treatment protocol of OA knee patients with mild-to-moderate degenerative changes.

Clinical and gait analysis of isolated soft tissue release surgery in crouch gait patients

Aim: The aim of this study was to evaluate whether isolated soft tissue release operation provides clinical and kinematic improvement in crouch gait, which is one of the major walking problems in cerebral palsy (CP) patients.Material Methods: This retrospective study included 32 limbs of 16 patients aged between 4 and 12 years with crouch gait walking pattern due to cerebral palsy between January 2004 and December 2013. All patients underwent multilevel isolated soft tissue release surgery. The preoperative and postoperative GMFSC level, clinical findings and gait analysis data of the patients were recorded. Pre-operative and post-operative data, which are obtained at post-op 6th month clinical examination and gait analysis, was compared.Results: A total of 114 lower extremity soft tissue segments (mean 7.1 segments) were operated. The most common surgery was medial hamstring lengthening (22). GMFCS score was 2.38±0.5 before operation, 1.69±0.4 at postoperative controls,and popliteal angle decreased from 65.2±11.9 to 60.15 (p 0.05) . There was no significant difference in the range of motion and joint forces of the hips, knees and ankle joints. According to the kinematic data, the minimum hip flexion (15.22±16.45 vs 7.33±14.34 p0.05), initial contact knee flexion (33.25±14.26 vs 24.46±8.84 p0.05) and maximum knee flexion in the swing phase (49.5±12 vs 43±11 p0.05) were declined and midstance foot ankle dorsiflexion (-3.02±1 vs. 3.75±7 p0.05) was increased. When the temporospatial data were compared, it was observed that cadence (104.71±38.5 vs 89.59±35.31 p 0.05), double support time (161.3±90.2 vs 150.09±81.91 p 0.05) decreased after surgery. While decrease in cadence was statistically significant, there was no significant difference between the double support time periods. However, step length (mm) (655.14±247.7 vs 767.5±307 p 0.05) and step width (mm)(144.41±50.61 147.94±87.8 p> 0.05) increased in postoperative evaluation.Conclusions: Single-session isolated soft tissue release surgeries have borth positive effect on clinical and functional outcomes in selected CP patients with crouch gait walking disorder. Priority should be to correct bone deformities in patients with bone deformity.Keywords: Multilevel isolated soft tissue surgery; crouch gate; cerebral palsy.

Effects of Cervical Stabilization Exercise Using Sling on Hamstring Flexibility in Patients with Chronic Neck Pain

Purpose: The primary purpose of this study was to investigate the effects of cervical stabilization exercise (CSE) on hamstring flexibility in patients with neck pain. A secondary purpose of this study was to investigate the effects of cervical range of motion (CROM) and craniovertebral angle (CVA). Methods: This study was a single-blind, randomized, comparative trial. Twenty patients were allocated into either the cranio-cervical flexion exercise (CCFE) group or the CSE group. Before and after the intervention, we measured straight leg raise (SLR), popliteal angle (PA), CROM, and CVA in the sitting and standing positions. Fisher’s exact test, the Mann-Whitney test, and Wilcoxon’s signed-rank test were used to analyze our data. Results: Both groups showed significant improvements in the value of SLR, PA, cervical extension, cervical rotation, and CVA in the standing position (both, p<.05) after intervention. However, only the CSE group showed significant improvements in cervical right lateral flexion (z=−2.209; p<.01) and cervical left lateral flexion (z=−2.537; p<.05) after intervention. The CSF group showed more significant improvements in SLR, PA, both cervical lateral flexions, and both cervical rotations than the CCFE group. Conclusions: The results of this study will guide future research in identifying the effectiveness of CSE. In conclusion, it can be inferred that CSE has a positive effect on SLR, PA, CROM, and CVA in the standing position in patients with chronic neck pain.

Short-term effects of the suboccipital muscle inhibition technique and cranio-cervical flexion exercise on hamstring flexibility, cranio-vertebral angle, and range of motion of the cervical spine in subjects with neck pain: A randomized controlled trial.

Cervical spinal instability often leads to neck pain and forward head posture (FHP). To improve neck pain and FHP, both the suboccipital muscle inhibition (SMI) technique and cranio-cervical flexion exercise (CCFE) have been used. However, little is known regarding the validity of hamstring flexibility in neck pain subjects after CCFE as a treatment index, and comparison between the SMI technique and CCFE for neck pain treatment. This study aimed to determine the short-term effects of SMI technique and CCFE, which represent passive and active exercise programs, respectively, and whether these improve the straight leg raise (SLR) test results, popliteal angle (PA), cranio-vertebral angle (CVA), and cervical range of motion (CROM) and are equally effective in immediate enhancement of such measures in neck pain subjects. Twenty subjects with neck pain were randomly allocated to the SMI and CCFE groups (n= 10 each). The outcomes were evaluated via clinical evaluation and SLR, PA, CVA, and CROM measurement before and after intervention. SLR test results, PA, CVA (sitting and standing), and CROM (flexion, extension, lateral flexion, and right and left rotations) after both interventions were significantly higher than those before the interventions (P< 0.05). The SLR test results (left), PA, and CVA (standing) after the SMI technique improved to levels similar to those observed after CCFE. Both the SMI technique and CCFE improve SLR test results, PA, CVA, and CROM and are equally effective in immediate enhancement of the hamstring flexibility, CVA, and CROM in subjects with neck pain.

Pre-operative hamstring length and velocity do not explain the reduced effectiveness of repeat hamstring lengthening in children with cerebral palsy and crouch gait

BackgroundHamstring lengthening surgery (HSL) is often performed to correct crouch gait in patients with cerebral palsy (CP). However, crouch can recur over time, and repeat HSL may be ineffective. One possible reason is that the hamstrings in repeat HSL patients are neither short nor lengthening slowly and would therefore not benefit from HSL. Research questionThis study aimed to determine whether the hamstrings are short and/or slow preoperatively only in patients with primary, and not repeat, HSL. MethodsWe compared pre- and postoperative dynamic semimembranosus muscle-tendon lengths for children with CP who had primary (N = 15) or repeat (N = 8) HSL to a group of control participants (N = 10). Outcome measures were compared between visits (pre- vs. postoperative) and groups (control, primary HSL, repeat HSL) using mixed model analysis. ResultsPreoperatively, hamstrings were shorter and slower than normal on average in both HSL groups (p < 0.001); all but 3 limbs (primary 26/28, repeat 13/14) had hamstrings that were shorter and/or slower than controls by more than two standard deviations. Postoperative improvements were observed in the primary HSL group for popliteal angle, initial contact knee flexion, minimum stance knee flexion, and dynamic hamstring length (p ≤ 0.001). The repeat HSL group improved only in dynamic hamstring length (p = 0.004) and worsened in passive knee extension (p = 0.01) and minimum hip flexion in stance (p = 0.04). Hamstrings in both surgical groups on average remained shorter and slower than controls postoperatively (p ≤ 0.001). SignificanceThe fact that repeat HSL is less effective in improving knee motion is not due to a lack of short or slow hamstrings preoperatively. However, in recurrent crouch, short or slow hamstrings do not usually indicate hamstring dysfunction, and correction of other deformities such as rotational malalignment, fixed knee flexion contractures, patella alta, weak calf muscles, and/or loose heelcords should be considered rather than repeat HSL.

P 141 - What is the effect on the popliteal angle of femoral anteversion increased in healthy individuals?

P 141 - What is the effect on the popliteal angle of femoral anteversion increased in healthy individuals?