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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 2, 248-254.
doi: 10.1302/0301-620X.88B2.16797  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Lengthening and transfer of hamstrings for a flexion deformity of the knee in children with bilateral cerebral palsy

TECHNIQUE AND PRELIMINARY RESULTS

F. Y. P. Ma, MB, BS, Research Fellow in Orthopaedic Surgery1; P. Selber, MD, FRACS, Consultant Orthopaedic Surgeon1; G. R. Nattrass, MD, FRCSC, FRACS, Consultant Orthopaedic Surgeon1; A. R. Harvey, BAppSc (PT), M.Physio, Research Physiotherapist1; R. Wolfe, PhD, Medical Statistician2; and H. K. Graham, MD, FRCS(Ed), FRACS, Professor of Orthopaedic Surgery3

1 Department of Orthopaedic Surgery, The Royal Children’s Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
2 Department of Epidemiology and Preventive Medicine Monash University, Alfred Hospital, Prahran 3004, Victoria, Australia.
3 Department of Orthopaedic Surgery, University of Melbourne and Murdoch Children’s Research Institute, Hugh Williamson Gait Laboratory, Flemington Road, Parkville, Victoria 3052, Australia.

Correspondence should be sent to Professor H. K. Graham; e-mail: kerr.graham{at}rch.org.au

Between July 2000 and April 2004, 19 patients with bilateral spastic cerebral palsy who required an assistive device to walk had combined lengthening-transfer of the medial hamstrings as part of multilevel surgery. A standardised physical examination, measurement of the Functional Mobility Scale score and video or instrumented gait analysis were performed pre- and post-operatively. Static parameters (popliteal angle, flexion deformity of the knee) and sagittal knee kinematic parameters (knee flexion at initial contact, minimum knee flexion during stance, mean knee flexion during stance) were recorded. The mean length of follow-up was 25 months (14 to 45).

Statistically significant improvements in static and dynamic outcome parameters were found, corresponding to improvements in gait and functional mobility as determined by the Functional Mobility Scale. Mild hyperextension of the knee during gait developed in two patients and was controlled by adjustment of their ankle-foot orthosis. Residual flexion deformity > 10° occurred in both knees of one patient and was treated by anterior distal femoral physeal stapling. Two children also showed an improvement of one level in the Gross Motor Function Classification System.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General