Muscle-tendon surgery in diplegic cerebral palsy: Functional and mechanical changes

A prospective assessment of muscle-tendon (M-T) surgery was conducted on 30 patients with spastic diplegia. Muscle-tendon surgery consisted of recessi ons or releases to improve gait function by correcting restricted joint mot ion and joint malalignment. Functional-outcome measures included the Gross Motor Function Measure (GMFM) and temporal gait factors. Kinematic gait dat a were evaluated to determine the mechanical effects. The mean age at surge ry was 8.7 years (4-20 years), and 3.5 muscle tendon units per extremity we re recessed or released at surgery. The primary kinematic change for the hi p and the knee was a shift in the sagittal joint position with minimal effe cts on overall excursion. Changes in ankle-joint dynamics after gastrocsole us recessions included a reduction in plantarflexion and a shift in the tim ing of maximal dorsiflexion to later in stance. Improvements in walking vel ocity and stride length were evident by 6 month after surgery. Functional c hanges from M-T surgery included a 25% increase in velocity and an 18% incr ease in stride length over preoperative values seen at 9 months after surge ry. Improvements in these parameters were maintained at 2 years after surge ry. The GMFM total score showed minimal change after surgery with improveme nts occurring primarily in the standing dimension and the walking, running, and jumping dimensions.