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An Evaluation of Surgery for the Correction of Knee-Flexion Contracture in Children with Cerebral Spastic Paralysis
Sidney Keats; Parviz Kambin
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Cerebral Palsy Clinic and Treatment Center, New Jersey Orthopedic Hospital, Hospital Center, Orange
1962 by The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 1962 Sep 01;44(6):1146-1154
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1. Flexion contracture of the knee is a common deformity in the child with cerebral palsy. If surgical relief of this deformity is indicated, it should be directed at two deforming elements, the overactivity of the spastic hamstring muscles and the deficiency of the quadriceps mechanism with an elongated patellar tendon.

2. Twenty-six patients were treated by one of the following procedures: transfer of the hamstring tendons to the femoral condyles (Eggers), transfer of the medial hamstrings only, or the combined procedure of transfer of the hamstring tendons and advancement of the patellar tendon.

3. Transfer of the hamstring tendons above the knee relieves knee-flexion contracture and improves hip extension. Advancement of the patellar tendon after transference of the hamstring produces superior clinical results and facilitates independent walking. Striking clinical improvement was observed in six of the seven patients who had the combined procedure.

4. Transfer of the medial hamstring tendons only and lengthening of the biceps femoris tendon, followed by advancement of the patellar tendon, may prove to be a more advantageous procedure and is currently under study.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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