Abstract

The objective of this study was to determine if surgical lengthening of the hamstrings and gastrocnemius/ Achilles complex affects muscle tone in patients with cerebral palsy. The question was if the dynamic component of muscle length changes after orthopedic surgery. A retrospective study was performed on ambulatory children with cerebral palsy who underwent either hamstring lengthening or gastrocnemius/ Achilles tendon lengthening. A total of 135 consecutive patients with an average age of 13 years were included in the study. A single random side was selected for children with bilateral surgery and the affected limb was analyzed for those undergoing unilateral surgery. The popliteal angle measurement was performed with a quick and slow stretch, as well as the ankle dorsiflexion, and measurements were made using a goniometer. The difference (Dml) between initial grab with fast stretch and end of range (EOR) with slow stretch was used as a measure of spasticity. The Bohannon modification of the Ashworth score was also assessed. Postoperatively, 18° popliteal angle improvement in end-of-range and 32° improvement in quick stretch in the hamstrings group were noted, with change in slow stretch, quick stretch and Dml (comparison between quick and slow stretch) being significant at p < .0001. In the triceps surae group, 14° ankle dorsiflexion improvement in end-of-range, and 18° improvement in quick stretch were noted postoperatively, with change in slow stretch, quick stretch and Dml at p < .0001, p < .0001, and p < .0180 respectively. Ashworth scale was reduced by at least one grade in 89% of subjects in the hamstring group and 78% of subjects in the triceps surae group of the children with preoperative Ashworth 3 and above.