Method of Soft Tissue Release of Lower Extremities in Cerebral Palsied Patients and Their Pre and Postoperative Gait

Abstract

The release of soft tissues of lower extremities was performed in 6 spastic diplegic patients with cerebral palsy who could walk independently with crouch gait, being aimed at improving gait in terms of both pattern and function. On the basis of long-term follow-up of the patients, the operative methods and gait before and after surgery were studied. Although all patients showed improvement in gait after surgery, those who had only soft tissue release revealed gait with internal rotation of hip joint and required additional osteotomy to reduce internal torsion. Following the fractional lengthening of the gastrocnemius muscle, gait with mild equinus deformity and excessive contraction still persisted at the time of toeoff. The lengthening of Achilles tendon using the triple cut was more effective to improve gait in terms of both pattern and function in the patients with equinus deformity. Since shortening of iliopsoas and hamstrings tended to recur, the procedure to diminish the strength of psoas muscle is therefore desirable. The procedure should be determined by dynamic assessment, and be performed on multi-joint muscles simultaneously to adjust multi-joint alignment, taking patient's age into consideration. Postoperative care such as exercise and orthoses is important.