Comparison of Percutaneous Versus Open Hamstring Lengthening in Patients of Spastic Diplegic Cerebral Palsy - A Randomized Controlled Trial

Introduction: Cerebral palsy (CP) often manifests with crouch gait due to hamstring spasticity, necessitating surgical intervention like hamstring lengthening surgery. Percutaneous techniques are emerging as an alternative to traditional open approaches in orthopedic surgeries.

Objectives: This randomized controlled trial aimed to compare the outcomes of percutaneous hamstring lengthening (pHSL) versus open hamstring lengthening (oHSL) in pediatric patients with spastic diplegic CP, focusing on improvements in gait and knee function.

Materials and methods: One hundred children diagnosed with spastic diplegic CP were randomized into pHSL (n = 50) and oHSL (n = 50) groups. Surgical procedures were performed using single-event multilevel surgery techniques. Pre-operative and post-operative assessments included range of motion, popliteal angle, gross motor function classification system (GMFCS) score, and gait analysis (functional independence measure [FIM], observational gait scale [OGS], physician gait scale). Statistical analyses were conducted using Statistical Packages for the Social Sciences v25.

Results: Both pHSL and oHSL groups showed significant improvements in popliteal angle and GMFCS scores postoperatively (P < 0.001 within each group). However, there were no significant differences between the groups in terms of these outcomes (P > 0.05). FIM, OGS, and physician gait scale also showed comparable improvements between groups (P > 0.05).

Conclusion: pHSL is as effective as oHSL in improving gait and knee function in pediatric patients with spastic diplegic CP. The percutaneous approach offers a safe and efficient alternative to traditional open surgery, potentially minimizing muscle damage and promoting quicker recovery.