Contracture of the hamstrings in spastic cerebral palsy. A study of three methods of operative correction.

The aim of this prospective study of postural fiexion deformity of the knee in spastic cerebral palsy was to acquire some experience of proximal elongation of the hamstrings, and then to compare the results of three different methods of operative correction. It was hoped in this way to establish the indications for treatment and the choice of operation. The reason why spastic patients often stand and walk with fiexion deformity of the knee may be flexion deformity of the hip ; the former often diminishes on correction of the latter (Roosth 1971, Reimers 1973). If knee fiexion still persists on weight-bearing it must be due to imbalance between the extensors and fiexors, an imbalance that will gradually lead to the development of contracture of the stronger flexors, the hamstrings (Sharrard 1967). Contracture of the hip fiexors is assessed with the patient lying supine on a flat surface. The opposite hip is flexed just enough to flatten the lumbar spine. The degree of contracture is then measured as the angle through which the thigh is raised (Fig. 1).