Lateral Hamstring Tendon Transfer around the Lateral Gastrocnemius Head and Medial Hamstring Lengthening to Correct Crouch Gait in Diaplegic Spastic Cerebral Palsy

Background: Hamstring muscles contracture is a major problem in the management of the cerebral palsy CP patient causing the crouch gait which is one of the most resistant conditions to treat. Methods: Twenty patients (40 knees) with spastic cerebral palsy diaplegia, between 7 – 12 years of age, presented to The National Institute of Neuromotor System of Egypt, from January 2010 to January 2011. All of the patients were diplegic and community ambulators but having knee flexion deformity and walking with crouch gait. All received previous conservative treatment for cerebral palsy in the form of muscle relaxants and physiotherapy, but no previous surgery. Ten were males and ten were females. All were evaluated clinically for the presence of spasticity and/or contracture, knee flexion deformity, popliteal angle, hip extension strength, and type of gait. All underwent lateral hamstring transfer around the proximal head of origin of gastrocnemius, as well as medial hamstring lengthening by Z-plasty and fractionally. Both knees of each patient were operated upon in the same sitting. Results: Clinical evaluation using a grading system revealed that 12 patients (60%) were classified as excellent, 6 patients (30%) as good, and 2 patients (10%) as fair. No poor cases were recorded. There was no complication. There was significant improvement in the result (p> 0.05). Conclusion: Transfer of the biceps tendon to just above the knee around the lateral head of origin of gastrocnemius, combined with appropriate Z-plasty lengthening of gracilis and semitendinosus tendons and fractional lengthening of semimembranosus being retained in position, is effective in relieving crouch gait in cerebral palsy with spastic diplegia. Level of Evidence: The study is type IV clinical evidence. Central Bishay (2015) Email: Ann Orthop Rheumatol 3(3): 1052 (2015) 2/5 January 2010 to January 2011; underwent lateral hamstring transfer and medial hamstring lengthening; and were included in this study. The results in this group, after at least three years of follow-up, were reported in January 2014 using previous medical records, history, and physical examinations.