Comparison between semitendinosus transfer to distal femur and medial hamstrings surgical lengthening for treatment of flexed knee gait in cerebral palsy

Abstract

Purpose: Hamstrings surgical lengthening (HSL) has been frequently used for the treatment of flexed knee gait in cerebral palsy; however, recurrence of knee flexion deformity (KFD) and increase of anterior pelvic tilt (APT) were reported in a long-term follow-up. Research question: The aim of this study was to compare semitendinosus transfer to distal femur (STTX) and semitendinosus surgical lengthening (STL) regarding the reduction of KFD and the increase of APT after flexed knee gait treatment. Methods: One hundred and eleven patients were evaluated and they were divided into two groups according to surgical procedures at knees: group A (65 patients/130 knees), including patients who received medial HSL as part of multilevel approach; group B (46 patients/92 knees), represented by patients who underwent orthopedic surgery including an STTX instead of STL. Results: Fixed knee flexion deformity (FKFD) decreased only in group B (from 6.79° to 2.96°, p < 0.001) after intervention. In kinematics, APT increased from 16.38° to 19.03° in group A ( p = 0.003), while group B also increased from 15.26° to 20.59° ( p < 0.001). The minimum knee flexion in stance phase (MKFS) reduced from 25.34° to 21.65° ( p = 0.016) in group A and from 31° to 19.57° ( p < 0.001) in group B. In the comparison between groups A and B, the increase of APT ( p = 0.028) and reduction of FKFD ( p < 0.001), popliteal angle ( p = 0.001), bilateral popliteal angle ( p = 0.003) and MKFS ( p = 0.006) were higher after STTX than STL. Conclusion: In the present study, patients who received STTX exhibited more improvement of knee extension at clinical examination and during gait than those who underwent to STL; however, STTX was not effective to prevent the increase of APT after flexed knee gait treatment.

Management of arthrofibrosis in neuromuscular disorders: a review

“…Moderately severe knee flexion deformities (flexion > 20° in stance phase of gait cycle, popliteal angle > 60°, sacral sitting) refractory to conservative treatments are traditionally managed by fractional hamstring lengthening (tenotomy of semitendinosus, gracilis and aponeurotic recession of semi-membranosis) with or without myoneural blockade [85][86][87]. Baumann et al show improvement in passive knee extension (restriction from 25° before surgery to 5° at average 32 months follow-up) after fractional hamstring lengthening in patients with spastic CP (n = 17) [88].…”

Finding consensus for hamstring surgery in ambulatory children with cerebral palsy using the Delphi method

“…More recently, however, there has been an increase in articles related to HST surgery. [43][44][45][46][47][48][49][50][51] From a theoretical basis, transfer of ST to the adductor tubercle may have the following advantages over HSL. It converts a two-joint muscle to a one-joint muscle, thereby simplifying its action.…”

“…46,47 Of the nine more recent studies in the literature reporting the outcomes of ST transfer, five studies compared HSL and HST and four reported HST only. [45][46][47][48][49][50][51] However, the studies were heterogeneous in terms of inclusion criteria, including GMFCS levels, as well as concomitant transfers and inclusion/exclusion of lateral HSL. The results were mixed, and some longitudinal studies from the same institution demonstrated that early differences between the HST and HSL groups dissipated over time.…”

Serebral palsi tedavisinde ortopedik cerrahide yenilikler: Alt ekstremite

“…Tek bir neden olmadığı için birçok farklı tedavi seçenekleri de bütüncül bir yaklaşım içinde değerlendirilmelidir (Şekil 18). [6,15,21,[30][31][32]…”