Article

Distal hamstring lengthening (DHL) is a commonly performed procedure in flexed
knee gait. However, the necessity of this procedure has been challenged due to
the concerns on adverse effects in long-term follow-up. This retrospective study
was undertaken to investigate the long-term outcome of single event multilevel
surgery (SEMLS), including bilateral DHL, in ambulatory patients with cerebral
palsy using 3D gait analysis. Twenty-nine ambulatory patients with spastic
diplegic cerebral palsy who had undergone SEMLS including bilateral DHL were
included. 3D gait analysis was performed preoperatively, 1 year postoperatively
and over 10 years postoperatively. Preoperative temporal parameters, kinematics
and GDI were compared with values obtained 1 and 10 year follow-up visits. The
mean age of patients at time of first surgery was 8.3 years (range, 5.4-16.3
years), and mean time from first surgery to last 3D gait analysis was 11.8 years
(range, 10.0-13.3 years). Mean pelvic tilt was not changed significantly after
SEMLS including DHL. Mean knee flexion at initial contact decreased from 31.1
degrees preoperatively to 26.0 degrees at 1 year postoperatively (p=0.065), and
then decreased significantly to 23.6 degrees at 10 years postoperatively
(p=0.038) versus the preoperative value. Mean GDI score significantly improved
from 69.4 preoperatively to 77.9 at 1 year postoperatively (p=0.003) and
continuously improved to 82.2 at 10 years postoperatively (p=0.017). Single event
multilevel surgery including DHL provides a favorable outcome 10 years
postoperatively in patients with spastic diplegic cerebral palsy.
CI - Copyright (c) 2012 Elsevier B.V. All rights reserved.

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