Objective

Hip internal rotation (HIR) during gait is one of the main functional disorders related to cerebral palsy (CP) in children. Most of the procedures proposed rotational osteotomy of the femur (FRO), (and/or tibia). However, multilevel surgery (SEMLS) including bone procedure, implicates more difficult and longer rehabilitation. When bone deformity is moderate, the authors hypothesized that FRO could be avoided.

They developed a soft tissues procedure to improve HIR. The aim of the study was assessment of the procedure.

Patients and methods

In walking CP the authors selected patients presented with femoral anteversion less than 40° who were proposed for soft tissue procedure alone. Patients were previously tested with botulinum toxin injection of the hamstring muscles. The soft tissue procedure was: lengthening of semimembranosus, transfer of semitendinosus associated with tenotomy of the gracilis and gluteus minimus muscles. All the patients with pre and postoperative full data (clinical, kinematics and kinetics) were included. Data (i.e. foot intoeing, dynamic hip internal rotation in stance phase, hip rotation moment) were collected. Follow-up was at least one year after SEMLS.

Results

We collected 20 selected patients with 24 lower limbs studied. Rotation of the pelvis did not differ significantly ( P = 0.21). Hip rotation in stance phase (50%), presented significant improvement from 16.5° intoeing to 0.5° external rotation ( P < 0.0001). Feet angulation related to walking direction was significantly improved, from 13° intoeing to 0.5° external rotation ( P < 0.0001).

Discussion/Conclusion

HIR is a frequent gait disorder in CP. The etiology of the HIR seems to be related to muscles contractures and spasticity. Recently, soft tissue procedures were reported of interest in HIR. The soft tissue procedures presented improved significantly HIR making pointless FRO. Rehabilitation should be making easier. Relevance: the authors improve significantly the HIR using a soft tissues procedure and advocated reducing indication for FRO in internal rotation of lower limbs in order to make easier rehabilitation after SEMLS.