Pre-operative gastrocnemius lengths in gait predict outcomes following gastrocnemius lengthening surgery in children with cerebral palsy

Apoorva Rajagopal, Łukasz Kidziński, Alec S. McGlaughlin, Jennifer L. Hicks, Scott L. Delp, Michael H. Schwartz

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Equinus deformity is one of the most common gait deformities in children with cerebral palsy. We examined whether estimates of gastrocnemius length in gait could identify limbs likely to have short-term and long-term improvements in ankle kinematics following gastrocnemius lengthening surgery to correct equinus. We retrospectively analyzed data of 891 limbs that underwent a single-event multi-level surgery (SEMLS), and categorized outcomes based on the normalcy of ankle kinematics. Limbs with short gastrocnemius lengths that received a gastrocnemius lengthening surgery as part of a SEMLS (case limbs) were 2.2 times more likely than overtreated limbs (i.e., limbs who did not have short lengths, but still received a lengthening surgery) to have a good surgical outcome at the follow-up gait visit (good outcome rate of 71% vs. 33%). Case limbs were 1.2 times more likely than control limbs (i.e., limbs that had short gastrocnemius lengths but no lengthening surgery) to have a good outcome (71% vs. 59%). Three-fourths of the case limbs with a good outcome at the follow-up gait visit maintained this outcome over time, compared to only one-half of the overtreated limbs. Our results caution against over-prescription of gastrocnemius lengthening surgery and suggest gastrocnemius lengths can be used to identify good surgical candidates.

Original languageEnglish (US)
Article numbere0233706
JournalPloS one
Issue number6
StatePublished - Jun 2020

Bibliographical note

Funding Information:
This work was funded by NIH grants U54EB020405, R24 HD065690, and P2C HD065690. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We would like to thank the staff of Gillette Children?s Specialty Healthcare Motion Analysis team for collecting and sharing subject data; Carmichael Ong and Rachel Jackson for the helpful discussions on the study and for feedback on the manuscript and figures.

Publisher Copyright:
This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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