Category: Clinical Sciences/Health Conditions
Case Diagnosis: cerebral palsy
Case Description: Knee flexion contracture in a patient with cerebral palsy was treated by a new tendon-lengthening technique using a tendon stripper. The patient was a 10-year-old girl with mixed types of cerebral palsy related to a chromosomal anomaly. She was classified as level IV in the Gross Motor Functional Classification System with a bilateral 30-40° knee flexion contracture.
Discussions: The semitendinosus and gracilis muscle tendons were released from distal to proximal using a tendon stripper. The pulled-out muscle tendons were placed on their original portions. In addition, the semimembranosus tendon and the tendon of the biceps femoris were lengthened by an intramuscular lengthening. After three weeks of casting, a long leg brace was made, and rehabilitation was started with full weight-bearing standing exercises. Three years and five months after the surgery, the improvement in maximum knee flexion contracture was maintained at 15° or less without severe progression or any complication.
Conclusions: This new technique of using the tendon stripper on knee flexion contracture for a patient with cerebral palsy can be safe, feasible, and effective.
Hirotaka Mutsuzaki– Professor, Ibaraki Prefectural University of Health Sciences / Department of Orthopaedic Surgery
Shogo Nakagawa– Medical doctor, Ibaraki Prefectural University of Health Sciences / Department of Orthopaedic Surgery
Yuki Mataki– Assistant professor, Ibaraki Prefectural University of Health Sciences / Department of Orthopaedic Surgery
Ryoko Takeuchi– Assistant professor, Ibaraki Prefectural University of Health Sciences / Department of Orthopaedic Surgery
Hiroshi Kamada– Assistant professor, University of Tsukuba / Department of Orthopaedic Surgery