Factors influencing outcomes after medial hamstring lengthening with semitendinosus transfer in patients with cerebral palsy.
Ki Hyuk Sung, Jaebong Lee, Chin Youb Chung and 5 others
PMID 28806980WHAT IT FOUND
Knee flexion and overall gait improved after multilevel surgery that included hamstring lengthening and transfer plus other procedures in ambulatory patients with CP.
Pelvic tilt stayed about the same. The contribution of the hamstring procedure alone cannot be separated.
Key findings
01At 2 years after surgery, estimated knee flexion at initial contact and minimum knee flexion in stance decreased by 8.7° and 6.0° in GMFCS level I and II, and by 8.1° and 5.0° in GMFCS level III.
02At 2 years after surgery, estimated knee range of motion and GDI score improved by 7.4° and 9.9 in GMFCS level I and II, and by 7.1° and 10.4 in GMFCS level III.
03Estimated mean pelvic tilt did not significantly change in patients with GMFCS level I and II or patients with GMFCS level III.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was retrospective, so follow-up intervals varied. There was no untreated comparison group, so natural progression cannot be separated from surgery. Outcomes were gait-lab measures, not everyday function or quality of life. Many patients had other surgeries at the same time, so the effect of any single procedure cannot be isolated. Tibial derotation osteotomy and foot surgery were not included as analysed concomitant surgeries. Serial long-term change could not be analysed for the highest GMFCS group because too few patients had enough repeated gait analyses.
Declared interests
The paper lists funding from the Ministry of Science, ICT and Future Planning and the Small and Medium Business Administration.
The easy way to misread this
Do not read the improved gait scores as evidence that hamstring surgery alone caused them. The patients had several surgeries at once, and the study had no untreated comparison group.