title: Achilles tendon length and medial gastrocnemius architecture in children with cerebral palsy and equinus gait.
abstract: BACKGROUND
  The aim of this study was to examine both the tendon and muscle components of the medial gastrocnemius muscle-tendon unit in children with cerebral palsy (CP) and equinus gait, with or without contracture. We also examined a small number of children who had undergone prior surgical lengthening of the triceps surae to address equinus contracture.
  
  
  METHODS
  Ultrasound was used to measure Achilles tendon length and muscle-tendon architectural parameters in children of ages 5 to 12 years. Muscle and tendon parameters were compared among 4 groups: Control group (N=40 limbs from 21 typically developing children), Static Equinus group (N=23 limbs from 15 children with CP and equinus contracture), Dynamic Equinus group (N=12 limbs from 7 children with CP and equinus gait without contracture), and Prior Surgery group (N=10 limbs from 6 children with CP who had prior gastrocnemius recession or tendo-achilles lengthening). The groups were compared using analysis of variance and Scheffe post hoc tests.
  
  
  RESULTS
  The CP groups had longer Achilles tendons and shorter muscle bellies than the Control group (P<0.001). Normalized tendon length was also longer in the Prior Surgery group compared with the Static Equinus group (P<0.001). The Prior Surgery group had larger pennation angles than the CP groups (P< or =0.009) and tended to have shorter muscle fascicle lengths (P< or =0.005 compared with Control and Static Equinus, P=0.08 compared with Dynamic Equinus). Similar results were observed for pennation angles and normalized muscle fascicle lengths throughout the range of motion.
  
  
  CONCLUSIONS
  Children with spastic CP and equinus gait have longer-than-normal Achilles tendons and shorter-than-normal muscle bellies. These characteristics are observed even in children with dynamic equinus, before contracture has developed. Surgery further lengthens the tendon, restoring dorsiflexion but not normal muscle-tendon architecture. These architectural features likely affect function, possibly contributing to functional deficits such as plantarflexor weakness after surgery.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: Children's Orthopaedic Center, CA, USA. twren@chla.usc.edu
authors.forename: Tishya A L
authors.initials: TA
authors.lastname: Wren
authors.forename: Allison P
authors.initials: AP
authors.lastname: Cheatwood
authors.forename: Susan A
authors.initials: SA
authors.lastname: Rethlefsen
authors.forename: Reiko
authors.initials: R
authors.lastname: Hara
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Perez
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kay
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology; D002675:Child, Preschool; D015331:Cohort Studies; D003286:Contracture / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D004863:Equinus Deformity / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome; D014463:Ultrasonography