title: Comparative effects of multilevel muscle tendon surgery, osteotomies, and dorsal rhizotomy on functional and gait outcome measures for children with cerebral palsy.
abstract: OBJECTIVE
  To compare the impact of common surgical interventions (selective dorsal rhizotomy, muscle-tendon surgery, and osteotomies) for patients with cerebral palsy (CP) on Gross Motor Function Measure and temporal, kinematic, and kinetic gait variables as assessed via 3-dimensional motion analysis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Motion analyses laboratory.
  
  
  METHODS
  Ninety-four patients with CP, 56 of whom underwent surgery (37, muscle-tendon surgery; 11, osteotomy; and 8, selective dorsal rhizotomy) and 38 of whom did not have surgery; the patients were ages 4-18 years, with a Gross Motor Function Classification System classification of I, II, or III.
  
  
  METHODS
  Single-event, multilevel muscle tendon surgery, selective dorsal rhizotomy, and osteotomy.
  
  
  METHODS
  Change scores (postintervention - preintervention) in Gross Motor Function Measure and temporal, kinematic, and kinetic gait variables.
  
  
  RESULTS
  No statistically significant differences in change scores were found between groups in the Gross Motor Function Measure, velocity, or stride length measures after the observation period. The selective dorsal rhizotomy group had greater improvements in knee extension when compared with the nonsurgical group and greater hip and knee total range of motion during the gait cycle when compared with nonsurgical group and the muscle-tendon surgery and osteotomy cohorts. Lastly, the muscle-tendon surgery group had greater improvements in total knee range of motion compared with the nonsurgical group.
  
  
  CONCLUSIONS
  Patients who undergo selective dorsal rhizotomy and, to a lesser extent, muscle tendon procedures demonstrate greater improvements in kinematic gait variables compared with nonsurgical interventions in patients with spasticity resulting from CP.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, PO Box 800232, Charlottesville, VA 22908-0232(∗). Electronic address: mf3de@virginia.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Feger
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, PO Box 800232, Charlottesville, VA 22908-0232(†).
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Lunsford
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, PO Box 800232, Charlottesville, VA 22908-0232(‡).
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Sauer
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, PO Box 800232, Charlottesville, VA 22908-0232(§).
authors.forename: Wendy
authors.initials: W
authors.lastname: Novicoff
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, PO Box 800232, Charlottesville, VA 22908-0232(¶).
authors.forename: Mark F
authors.initials: MF
authors.lastname: Abel
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology; D010027:Osteotomy; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D019051:Rhizotomy; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome