Acta Ortopédica Mexicana

De Pavía-Mota E, Neri-Gámez S, Reyes-Contreras G, Valencia-Posadas M
Percutaneous tenotomy and aponeurotomy (PTA) for knee flexor contracture in children with spastic cerebral palsy
Acta Ortop Mex 2013; 27 (2)

Language: Español
References: 14
Page: 109-113
PDF: 84.10 Kb.

[Fulltext - PDF]


Knee flexor muscle contracture is frequent in patients with spastic cerebral palsy. The purpose of the study was to determine whether percutaneous tenotomy and aponeurotomy may decrease knee flexor contracture in children with spastic cerebral palsy. Material and methods: A prospective study of consecutive cases was conducted from January to December 2009 in 24 children with a diagnosis of moderate to severe spastic cerebral palsy who had knee flexor contracture with a popliteal angle ≥ 45° and a gross motor function classification scale of 4 or 5; they underwent percutaneous tenotomy and aponeurotomy surgery and were followed-up for 24 months. Variance analysis with a factorial design was used for data analysis. Results: The mean popliteal angle was 83.48° preoperatively and 27.30° by the end of the follow-up, with an improvement of 56.18° (p < 0.01). Statistically significant differences were found in all measurements comparing them with the baseline values. Discussion: Percutaneous aponeurotomy of knee flexor muscles is described. Compared to other procedures it provides the benefits of minimally invasive surgery, mild postoperative pain, short hospital stay –without using immobilization during the entire process- and children returned to their therapy program within fi ve days. Conclusion: Percutaneous tenotomy and aponeurotomy of knee flexors was shown to be a good alternative for the treatment of knee flexor contracture in patients with spastic cerebral palsy.

Key words: knee, cerebral palsy, tenotomy, mobility limitation.


  1. Herring JA: Disorders of the brain. In: Tachdjian’s pediatric orthopedics. Vol. 2. 3rd ed. Philadelphia: W. B. Saunders; 2002.

  2. Suso S, López S, Forés J, Ferreres A, Gutierrez-Carbonel P. Cirugía paliativa de la parálisis espástica en las extremidades superiores. Rev Neurol 2003; 37(5): 454-58.

  3. Bleck EE: Management of the lower extremities in children who have cerebral palsy. J Bone Joint Surg Am 1990; 72: 140-44.

  4. Rose J, Haskell WL, Gamble JG, Hamilton RL, Brown DA, Rinsky L: Muscle pathology and clinical measures of disability in children with cerebral palsy. J Orthop Research 1994; 12(6): 758-68.

  5. Shortland AP, Harris CA, Gouch M, Robinson RO: Architecture of the medial gastrocnemius in children with spastic diplegia. Developmental Medicine & Child Neurology 2002; 44: 158-63.

  6. Reimers J: Contracture of the hamstrings in spastic cerebral palsy. A Study of Three Methods of Operative Correction. J Bone Joint Surg Br 1974; 56B(1): 102-9.

  7. Beals R: Treatment of knee contracture in cerebral palsy by hamstring lengthening, posterior capsulotomy and cuadriceps mechanism shortening. Developmental Medicine & Child Neurology 2001; 43: 802-5.

  8. Banks H, Green W. The correction of equinus deformity in cerebral palsy. J Bone Joint Surg Am 1958; 40: 1359-79.

  9. Dhawlikar SH, Root L, Mann RL: Distal lengthening of the hamgstrings in patients who have cerebral palsy. Long-term retrospective analysis. J Bone Joint Surg Am 1992; 74: 1385-91.

  10. Hsu LC, Li HS: Distal hamstring elongation in the management of spastic cerebral palsy. J Pediatr Orthop 1990; 10: 378-81.

  11. Damron T, Breed AL, Roecker E: Hamstring tenotomies in cerebral palsy: long-term retrospective analysis. J Pediatr Orthop 1991; 11: 514-19.

  12. Jones S, Al Hussainy H, Ali F, et al: Distal hamstring lengthening in cerebral palsy: the infl uence of the proximal aponeurotic band of the semimembranous. J Pediatr Orthop B 2006; 15(2): 104-8.

  13. Ley General de Salud. Diario Ofi cial de la Federación (26 de Enero de 1982).

  14. Hulley S. Diseño de la Investigación clínica. Barcelona: Doyma; 1993.