Article

Crouch gait is common in individuals with cerebral palsy. Recently published data
has shown that distal femoral extension osteotomy with patellar tendon
advancement (DFEO/PTA) is an effective procedure to correct crouch gait in the
presence of a knee flexion contracture and quadriceps insufficiency. Short length
and slow lengthening rate (velocity) of the hamstrings are indications for
hamstrings surgery. We empirically believed that hamstrings surgery would not be
necessary to improve hamstring function when DFEO/PTA are performed. This
hypothesis was examined in a retrospective review of hamstrings length and
velocity before and after DFEO/PTA. 51 limbs in 32 individuals with a diagnosis
of CP who underwent DFEO/PTA without concomitant hamstring surgery were included
in the study. Pre and post-operative peak medial hamstring length and velocity
z-scores were calculated using a musculoskeletal model. A subset of limbs with
pre-operative values above or below two SD from the control mean emerged and were
called long or short respectively. Members of this subset would often be
considered candidates for hamstrings surgery. Categorical length outcomes were
derived, with analogous categories for velocity. The mean peak hamstring length
z-score improved pre- to post-operatively from -2.2 to -0.76 (p<0.001). The mean
peak velocity z-score improved from -3.1 to -1.5 (p<0.001) [Figure 1]. DFEO/PTA
surgery without concomitant hamstrings surgery led to significantly longer or
faster hamstrings. Specifically, we saw 94% good or neutral results for length
correction and 80% good or neutral results for velocity correction. Because
crouch improved without posterior pelvic tilting, and because both hamstring
length and velocity increased substantially, we conclude that concomitant
hamstring surgery is rarely needed when performing DFEO/PTA.
CI - Copyright (c) 2010 Elsevier B.V. All rights reserved.

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