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Effects of distal hamstring lengthening and rectus femoris transfer on sagittal motion in patients with diplegia-hamstring length and its clinical use

M PARK MD 1, C CHUNG MD 1, K LEE MD 1, S LEE MD 1,
M PARK 2

1. Orthopaedic surgery, Seoul National University Bundang Hospital, Sungnam, Korea, South;
2. Motion Analysis Korea, Seoul, Korea, South

Background/Objectives: The aim of this study was to determine the effect of distal hamstring lengthening and rectus femoris transfer on sagittal motion as well as the feasibility of using hamstring length clinically.

Design: Retrospective case series.

Participants and Setting: Twenty-eight patients with spastic diplegic cerebral palsy who underwent bilaterally distal hamstring lengthening with tendo-Achilles lengthening (DHL group, 8 patients, 16 limbs; mean age 7.3 years, SD 2.8 years), or distal hamstring lengthening and rectus femoris transfer with tendo-Achilles lengthening (DHL+RFT group, 20 patients, 40 limbs; mean age 7.4 years, SD 2.4 years) were included. All confounding surgeries were excluded. This study was performed at the setting of a tertiary referral hospital.

Materials/Methods: Kinematic data was obtained by gait analysis, and hamstring length was obtained using a musculoskeletal modeling technique pre- and post-operatively. Changes of kinematic variables and hamstring length were compared between the two groups. Correlation between kinematic variables and hamstring length was analyzed.

Results: Mean hamstring length was significantly correlated with mean pelvic tilt (r=0.894, P<0.001), while maximum hamstring length was not correlated with knee flexion at initial heel contact (r=0.066, P=0.595). In the DHL group, mean hamstring length increased significantly after surgery causing a 2.2 0 increase in mean pelvic tilt (P=0.011), whereas there was 10 0 decrease in knee flexion at initial contact (P=0.011) that was not related to the change in hamstring length. In the DHL+RFT group after surgery, there were no significant changes in pelvic tilt or hamstring length, while there was significant improvement in knee motion (Table).

Conclusions/Significance: Distal hamstring lengthening can aggravate pelvic tilt by elongating hamstring length, which can be avoided by rectus femoris transfer. Although there was a strong correlation between the hamstring length and pelvic tilt, it was not associated with the improved knee motion after surgery. A long “3D graphic modeled” hamstring length is not necessarily a contraindication for distal hamstring lengthening.

 
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