Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 4;58(6):680-686.
doi: 10.1007/s43465-024-01165-9. eCollection 2024 Jun.

Lower Extremity Muscle Tendon Interaction Around Knee During Gait Among Adolescent Children with Cerebral Palsy with Varying Crouch Angle

Triveni Shetty  1 , Rajani Mullerpatan  1 , Sailakshmi Ganesan  1 , Ashok N Johari  2
Affiliations

Lower Extremity Muscle Tendon Interaction Around Knee During Gait Among Adolescent Children with Cerebral Palsy with Varying Crouch Angle

Triveni Shetty et al. Indian J Orthop. .

Abstract

Background: Optimal management and surgical planning of severe bony deformities and muscle tendon unit contractures demands comprehensive evaluation of all structures including the dynamic muscle tendon length of all muscles around the joint during gait.

Objectives: Present study aimed to explore dynamic muscle-tendon length for all muscles around the knee joint along with pelvis, hip, and ankle joint kinematics among adolescent children with varying crouch angle.

Methods: Muscle-tendon length of 29 adolescent children with cerebral palsy with varying crouch angles was computed using a full-body musculo-skeletal model and expressed as a percentage of muscle-tendon length during walking compared to resting condition.

Results: Children with knee flexion angle greater than 25° demonstrated lower anterior pelvic tilt and 11% greater muscle-tendon length of semimembranosus and biceps femoris during stance phase of gait compared to children with knee flexion angle less than 25° and typically developing children (p < 0.01).

Conclusions: The findings of present study reported that routine bedside clinical evaluation in adolescent children with knee flexion angle greater than 25° revealed moderate shortening of hamstring muscle in supine position. Whereas instrumented objective evaluation of gait demonstrated lengthened hamstring muscle and reduced hip extension and relatively lower anterior pelvic tilt. Therefore, it may be valuable to add objective assessment of dynamic muscle-tendon length to kinematics of all lower-extremity joint motion during gait, in order to understand the muscle-joint interactions; particularly in children with severe crouch and plan specific, tailor-made surgical and non-surgical interventions.

Keywords: Adolescent children with cerebral palsy; Dynamic muscle tendon interaction; Greater crouch angle; Hamstring length.

PubMed Disclaimer

Conflict of interest statement

Conflict of InterestThe authors state that they have no conflict of interest, financial or otherwise, concerning the material or methods used in this study or the findings specified in this paper.

Figures

Fig. 1
Fig. 1
Association of anterior pelvic tilt and magnitude of crouch angle
Fig. 2
Fig. 2
Hamstring muscle tendon length in children with varying crouch angle
See this image and copyright information in PMC

References

    1. Gough M, Eve LC, Robinson RO, Shortland AP. Short-term outcome of multilevel surgical intervention in spastic diplegic cerebral palsy compared with the natural history. Developmental Medicine and Child Neurology. 2004;46(2):91–97. doi: 10.1017/s0012162204000192. - DOI - PubMed
    1. Svehlík M, Steinwender G, Kraus T, Saraph V, Lehmann T, Linhart WE, Zwick EB. The influence of age at single-event multilevel surgery on outcome in children with cerebral palsy who walk with flexed knee gait. Developmental Medicine and Child Neurology. 2011;53(8):730–735. doi: 10.1111/j.1469-8749.2011.03995.x. - DOI - PubMed
    1. Arnold AS, Liu MQ, Schwartz MH, Ounpuu S, Delp SL. The role of estimating muscle-tendon lengths and velocities of the hamstrings in the evaluation and treatment of crouch gait. Gait & Posture. 2006;23(3):273–281. doi: 10.1016/j.gaitpost.2005.03.003. - DOI - PubMed
    1. Delp SL, Arnold AS, Speers RA, Moore CA. Hamstrings and psoas lengths during normal and crouch gait: implications for muscle-tendon surgery. Journal of Orthopaedic Research. 1996;14(1):144–151. doi: 10.1002/jor.1100140123. - DOI - PubMed
    1. Jonkers I, Stewart C, Desloovere K, Molenaers G, Spaepen A. Musculo-tendon length and lengthening velocity of rectus femoris in stiff knee gait. Gait & Posture. 2006;23(2):222–229. doi: 10.1016/j.gaitpost.2005.02.005. - DOI - PubMed

LinkOut - more resources