Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study

Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study

Haberfehlner, Helga (Vrije Universiteit Amsterdam)
Jaspers, Richard T. (Vrije Universiteit Amsterdam)
Rutz, Erich (University Children’s Hospital Basle)
Harlaar, J. (TU Delft Biomechatronics & Human-Machine Control; Amsterdam UMC)
Van Der Sluijs, Johannes A. (Amsterdam UMC)
Witbreuk, Melinda (Amsterdam UMC)
van Hutten, Kim (Amsterdam UMC)
Romkes, Jacqueline (University Children’s Hospital Basle)
Freslier, Marie (University Children’s Hospital Basle)
Brunner, Reinald (University Children’s Hospital Basle)
Becher, Jules G. (Amsterdam UMC)
Maas, H. (Vrije Universiteit Amsterdam)
Buizer, Annemieke I. (Amsterdam UMC)

2018

To improve gait in children with spastic paresis due to cerebral palsy or hereditary spastic paresis, the semitendinosus muscle is frequently lengthened amongst other medial hamstring muscles by orthopaedic surgery. Side effects on gait due to weakening of the hamstring muscles and overcorrections have been reported. How these side effects relate to semitendinosus morphology is unknown. This study assessed the effects of bilateral medial hamstring lengthening as part of single-event multilevel surgery (SEMLS) on (1) knee joint mechanics (2) semitendinosus muscle morphology and (3) gait kinematics. All variables were assessed for the right side only. Six children with spastic paresis selected for surgery to counteract limited knee range of motion were measured before and about a year after surgery. After surgery, in most subjects popliteal angle decreased and knee moment-angle curves were shifted towards a more extended knee joint, semitendinosus muscle belly length was approximately 30% decreased, while at all assessed knee angles tendon length was increased by about 80%. In the majority of children muscle volume of the semitendinosus muscle decreased substantially suggesting a reduction of physiological cross-sectional area. Gait kinematics showed more knee extension during stance (mean change ± standard deviation: 34±13), but also increased pelvic anterior tilt (mean change ± standard deviation: 23±5). In most subjects, surgical lengthening of semitendinosus tendon contributed to more extended knee joint angle during static measurements as well as during gait, whereas extensibility of semitendinosus muscle belly was decreased. Post-surgical treatment to maintain muscle belly length and physiological cross-sectional area may improve treatment outcome of medial hamstring lengthening.

http://resolver.tudelft.nl/uuid:132fb82e-4f9d-4b2e-b38d-b96a53965749

https://doi.org/10.1371/journal.pone.0192573

1932-6203

PLoS ONE, 13 (2)

Institutional Repository

journal article

© 2018 Helga Haberfehlner, Richard T. Jaspers, Erich Rutz, J. Harlaar, Johannes A. Van Der Sluijs, Melinda Witbreuk, Kim van Hutten, Jacqueline Romkes, Marie Freslier, Reinald Brunner, Jules G. Becher, H. Maas, Annemieke I. Buizer