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

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

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Article numbere0192573
JournalPLoS ONE
Volume13
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018

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paresis
Muscle Spasticity
knees
Paresis
observational studies
semitendinosus muscle
Observational Studies
Muscle
gait
Gait
surgery
Surgery
Muscles
Knee
Knee Joint
muscles
tendons
kinematics
Tendons
Biomechanical Phenomena

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Haberfehlner, H., Jaspers, R. T., Rutz, E., Harlaar, J., Van Der Sluijs, J. A., Witbreuk, M. M., ... Buizer, A. I. (2018). Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study. PLoS ONE, 13(2), [e0192573]. https://doi.org/10.1371/journal.pone.0192573
Haberfehlner, Helga ; Jaspers, Richard T. ; Rutz, Erich ; Harlaar, Jaap ; Van Der Sluijs, Johannes A. ; Witbreuk, Melinda M. ; van Hutten, Kim ; Romkes, Jacqueline ; Freslier, Marie ; Brunner, Reinald ; Becher, Jules G. ; Maas, Huub ; Buizer, Annemieke I. / Outcome of medial hamstring lengthening in children with spastic paresis : A biomechanical and morphological observational study. In: PLoS ONE. 2018 ; Vol. 13, No. 2.
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abstract = "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.",
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Haberfehlner, H, Jaspers, RT, Rutz, E, Harlaar, J, Van Der Sluijs, JA, Witbreuk, MM, van Hutten, K, Romkes, J, Freslier, M, Brunner, R, Becher, JG, Maas, H & Buizer, AI 2018, 'Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study' PLoS ONE, vol. 13, no. 2, e0192573. https://doi.org/10.1371/journal.pone.0192573

Outcome of medial hamstring lengthening in children with spastic paresis : A biomechanical and morphological observational study. / Haberfehlner, Helga; Jaspers, Richard T.; Rutz, Erich; Harlaar, Jaap; Van Der Sluijs, Johannes A.; Witbreuk, Melinda M.; van Hutten, Kim; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Becher, Jules G.; Maas, Huub; Buizer, Annemieke I.

In: PLoS ONE, Vol. 13, No. 2, e0192573, 01.02.2018.

Research output: Contribution to JournalArticleAcademicpeer-review

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T2 - A biomechanical and morphological observational study

AU - Haberfehlner, Helga

AU - Jaspers, Richard T.

AU - Rutz, Erich

AU - Harlaar, Jaap

AU - Van Der Sluijs, Johannes A.

AU - Witbreuk, Melinda M.

AU - van Hutten, Kim

AU - Romkes, Jacqueline

AU - Freslier, Marie

AU - Brunner, Reinald

AU - Becher, Jules G.

AU - Maas, Huub

AU - Buizer, Annemieke I.

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