The role of estimating muscle-tendon lengths and velocities of the hamstrings in the evaluation and treatment of crouch gait

Persons with cerebral palsy frequently walk with excessive knee flexion during terminal swing and stance. This gait abnormality is often attributed to "short" or "spastic" hamstrings that restrict knee extension, and is often treated by hamstrings lengthening surgery. At present, the outcomes of these procedures are inconsistent. This study examined whether analyses of the muscle-tendon lengths and lengthening velocities of patients' hamstrings during walking may be helpful when deciding whether a candidate is likely to benefit from hamstrings surgery. One hundred and fifty-two subjects were cross-classified in a series of multi-way contingency tables based on their pre- and postoperative gait kinematics, muscle-tendon lengths, muscle-tendon velocities, and hamstrings surgeries. The lengths and velocities of the subjects' semimembranosus muscles were estimated by combining kinematic data from gait analysis with a three-dimensional computer model of the lower extremity. Log-linear analysis revealed that the subjects who walked with abnormally "short" or "slow" hamstrings preoperatively, and whose hamstrings did not operate at longer lengths or faster velocities postoperatively, were unlikely to walk with improved knee extension after treatment (p < 0.05). Subjects who did not walk with abnormally short or slow hamstrings preoperatively, and whose hamstrings did operate at longer lengths or faster velocities postoperatively, tended to exhibit unimproved or worsened anterior pelvic tilt after treatment (p < 0.05). Examination of the muscle-tendon lengths and velocities allows individuals who walk with abnormally short or slow hamstrings to be distinguished from those who do not, and thus may help to identify patients who are at risk for unsatisfactory postsurgical changes in knee extension or anterior pelvic tilt.