Child Orthopedics

Frequently Asked Questions

My nine-year old daughter has spastic diplegia, a type of cerebral palsy. Last year she had a hamstring lengthening operation to help her walk better. For awhile she looked better but now she's starting to bend at the knees and crouch again. Is this just a bad habit that she can overcome by trying harder?

When cerebral palsy (CP) affects just the legs, it's called spastic diplegia. Spastic refers to the spasticity that is a part of this condition. Spasticity is caused by brain damage associated with the CP. It results in constant increased muscle tone and contractions.

Since we haven't found a way to improve the brain's function to overcome spasticity, treatment is focused on the muscles. Surgery to lengthen the muscles is common and works to some extent. Hamstring lengthening can be helpful for the child whose spasticity pulls him or her into a crouched position when standing and walking.

Motion analysis studies of children with spastic diplegia before and after surgery help identify some of the benefits of the operations performed. A group of orthopedic surgeons in Kentucky looked at the effect of hamstring lengthening on hip rotation and the crouch position.

They found that although hip rotation didn't change when measured, the children were able to walk with more normal hip motion. Some children needed another surgery to release other hip muscles.

The effect doesn't always last. Gravity exerts a constant downward pull on muscles and bone that are already compromised by this condition. The bones grow longer but the muscles don't stretch to keep up. A growth spurt can make it look as if the child just got worse.

If your child is starting to crouch again after a period of improvement, it's likely due to a combination of the reasons stated. Reminders to stand up straight and even attempts to do so don't usually work.

It may be time for a follow-up appointment with her orthopedic surgeon to see if anything else needs to be done. She may only need some physical therapy to get back on track. Or she may be a candidate for further surgery.

Steven A. Lovejoy, MD, et al. The Effects of Hamstring Lengthening on Hip Rotation. In Journal of Pediatric Orthopaedics. March 2007. Vol. 27. No. 2. Pp. 142.

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