cerebral palsy and the types of tendon surgeries done. cerebral palsy: It is an umbrella term used for static/ non progressive disorders of the brain affecting the development of movement, posture and coordination resulting from a lesion of an immature brain.
2. DEFINITION
It is an umbrella term used for static/ non progressive disorders of the brain affecting the
development of movement, posture and coordination resulting from a lesion of an
immature brain.
3. Before surgery
• respiratory care
• muscle power
• muscle strength: grade 4
• splints and assistive devices: measurements
• functional activities training
4. Tendon Transfer or Lengthening for Children with CP
Tendons are bands of tissue that help attach muscles to bones. Tendons and muscles
function as one unit, making it possible for our bodies to move.
Cerebral palsy can make muscles and tendons tight. This tightness, also called a contracture,
may shorten the muscles and tendons over time. This condition commonly affects the lower
extremities. It can cause pain and create abnormalities in the tendons and muscles that affect
a child’s mobility. Two of the most common surgeries for contractures are tendon transfers
and muscle lengthening procedures.
5. Tendon surgeries can help:
• Increase range of motion.
• Make sitting, standing and walking more comfortable.
• Reduce pain
When to Have Tendon Transfer / Lengthening for Cerebral Palsy
• In general children should have tendon transfer / lengthening surgery before their
bones fully mature. Often the best age is between 6 and 10 years old.
6. Types of Tendon Transfer / Lengthening Surgeries
Orthopedic surgeries for contractures typically target the following muscles and
tendons:
• Gastrocnemius / soleus complex (calf area) : ACHILLES TENDON
• Hip flexor complex
• Hamstring complex (back of the thigh)
• Rectus femoris complex (near the knee)
7. 1. Gastrocnemius / Soleus Complex (Calf Area)
The Achilles tendon connects the muscles in the back of
the calf (gastrocnemius and soleus muscles) to the heel
bone. Contractures can make these calf muscles too tight,
causing pain and problems with walking. It may also
cause children to walk on tiptoes (unable to do
dorsiflexion), which is typical for young walkers. Toe
walking after age 3 may be a concern and is a reason for
medical consultation. The goal of this surgery is for your
child to walk with heels on the floor and knees straight.
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11. 2. Hip Flexor Complex
• The hip flexor tendon connects two inner hip muscles
(the iliacus and psoas major) to the thigh bone. The
tendon helps a child to bend at the hips, sit, stand and
walk. If the muscles are tight, it can start to pull the
femur (thigh bone) away from the hip, affecting how the
child walks.
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13. 3. Hamstring Complex
• Hamstring tendons connect the hamstring muscles to the
pelvis, knee and shin bones. When the tendons are too
short and tight, they can cause pain and problems with
walking and sitting. Tendon transfer and / or muscle
lengthening enables to extend and straighten the knee.
This makes walking and sitting more comfortable.
• Hamstring lengthening is more common than tendon
transfer, but sometimes a tendon transfer may be
beneficial.
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16. 5. Rectus Femoris Complex
• The rectus femoris complex is located in the front of the leg. It
allows the knee to straighten and the hip to bend. Contractures
in the rectus femoris complex can make the muscles around the
knee too stiff. This may cause problems with walking,
including tripping.
• Tendon transfer surgery involves removing the rectus femoris
tendon from the top of the kneecap. The tendon is then
transferred and reattached to a muscle on the inside back of the
leg, just above the knee. This allows the rectus femoris muscle
to bend the knee instead of straightening the knee.
