title: Long term outcome of single event multilevel surgery in spastic diplegia with flexed knee gait.
abstract: Distal hamstring lengthening (DHL) is a commonly performed procedure in flexed knee gait. However, the necessity of this procedure has been challenged due to the concerns on adverse effects in long-term follow-up. This retrospective study was undertaken to investigate the long-term outcome of single event multilevel surgery (SEMLS), including bilateral DHL, in ambulatory patients with cerebral palsy using 3D gait analysis. Twenty-nine ambulatory patients with spastic diplegic cerebral palsy who had undergone SEMLS including bilateral DHL were included. 3D gait analysis was performed preoperatively, 1 year postoperatively and over 10 years postoperatively. Preoperative temporal parameters, kinematics and GDI were compared with values obtained 1 and 10 year follow-up visits. The mean age of patients at time of first surgery was 8.3 years (range, 5.4-16.3 years), and mean time from first surgery to last 3D gait analysis was 11.8 years (range, 10.0-13.3 years). Mean pelvic tilt was not changed significantly after SEMLS including DHL. Mean knee flexion at initial contact decreased from 31.1° preoperatively to 26.0° at 1 year postoperatively (p=0.065), and then decreased significantly to 23.6° at 10 years postoperatively (p=0.038) versus the preoperative value. Mean GDI score significantly improved from 69.4 preoperatively to 77.9 at 1 year postoperatively (p=0.003) and continuously improved to 82.2 at 10 years postoperatively (p=0.017). Single event multilevel surgery including DHL provides a favorable outcome 10 years postoperatively in patients with spastic diplegic cerebral palsy.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Republic of Korea.
authors.forename: Ki Hyuk
authors.initials: KH
authors.lastname: Sung
authors.forename: Chin Youb
authors.initials: CY
authors.lastname: Chung
authors.forename: Kyoung Min
authors.initials: KM
authors.lastname: Lee
authors.forename: Bekhzad
authors.initials: B
authors.lastname: Akhmedov
authors.forename: Seung Yeol
authors.initials: SY
authors.lastname: Lee
authors.forename: In Ho
authors.initials: IH
authors.lastname: Choi
authors.forename: Tae-Joon
authors.initials: TJ
authors.lastname: Cho
authors.forename: Won Joon
authors.initials: WJ
authors.lastname: Yoo
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D058971:Tenotomy; D013848:Thigh; D016896:Treatment Outcome