Quantification of patellar tendon shortening in a patient with cerebral palsy

ABStrA ct Purpose: In the last few years the use of patellar tendon shortening procedure appears to give good results for the treat- ment of crouch gait in cerebral Palsy (cP) patients. It offers a secondary approach in cases where conventional hamstrings lengthening failed. t he evidence for the effectiveness of knee extensor shortening is poor and only one study quantitatively assessed the effects of this technique performed in addition to other procedures in cP patients. In this case study we used Gait Analysis (GA) to quantify the effects of patellar tendon shortening for the management of crouch gait persisting after hamstring lengthening. Methods: crouch persisted seven years after a first multilevel procedure including hamstring lengthening in a 15-year old male. Gait was assessed over time (before and from six to 18 months after knee extensor shortening) with Gait Analysis (GA). Results: Before treatment the patient walked slowly and with a high duration stance phase; sagittal kinematics revealed excessive hip and knee flexion and ankle dorsiflexion during the whole gait cycle. After surgery, data showed progressive significant improvements at all lower limb levels during the follow-ups considered; gait became more physiologic and lower limb joint kinematics improved overall. Conclusions: t he results demonstrated that addressing the other side and shortening the antagonists may be a valuable op- tion to treat crouch gait in patients with cP especially if this persists after hamstring and knee extension surgery.