title: [The results of single-stage multilevel muscle-tendon surgery in the lower extremities of patients with spastic cerebral palsy].
abstract: OBJECTIVE
  We evaluated the results of single-stage multilevel muscle-tendon surgery performed for the treatment of contractures in the lower extremities of patients with spastic cerebral palsy.
  
  
  METHODS
  The study included 23 patients (11 girls, 12 boys; mean age 6 years 3 months; range 4 to 17 years) with spastic cerebral palsy, who underwent single-stage multilevel muscle-tendon surgery for the treatment of contractures in the lower extremities secondary to spasticity. Quadriplegia, diplegia, and hemiplegia were present in five, 14, and four patients, respectively. Preoperatively, 13 patients could walk, while 10 patients lacked ambulation even with support. Evaluations were based on pre- and postoperative (mean 4 years 9 months; range 1 to 8 years) physical examination findings and on the Gross Motor Function Classification System (GMFCS) scores. The patients' mean age at the last follow-up was 11.5 years (range 9 to 19 years).
  
  
  RESULTS
  The range of motion of all the operated joints improved postoperatively, resulting in significant improvements in posture, sitting, gait, and hygiene of the patients. Of ten patients who could not walk, five could ambulate with the use of a walker or crutches postoperatively. The mean pre- and postoperative GMFCS scores were 3.045 and 1.864, respectively (p<0.001). All the patients showed an improvement of at least one GMFCS level.
  
  
  CONCLUSIONS
  Surgery for spastic cerebral palsy can be most beneficial only when all contractures of the hip, knee, and ankle have been corrected. Symmetrical and multilevel operations should be performed when necessary, for single-stage and symmetrical multilevel muscle-tendon surgical applications have definite advantages over staged interventions.
authors.affiliation: Department of Orthopedics and Traumatology (1. Ortopedi ve Travmatoloji Kliniği), SSK Istanbul Training Hospital, Istanbul, Turkey.
authors.forename: Gazi
authors.initials: G
authors.lastname: Zorer
authors.forename: Cemal
authors.initials: C
authors.lastname: Doğrul
authors.forename: Mehmet
authors.initials: M
authors.lastname: Albayrak
authors.forename: A Erdem
authors.initials: AE
authors.lastname: Bagatur
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery*; D016059:Range of Motion, Articular; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome