Abstract
Aim: To introduce a mini-invasive surgical treatment for lengthening of knee flexors in cerebral palsied children.
Material and methods: Operation is performed in prone position under tourniquet control. The trocar (4mm) is introduced from middle thirds of dorsal surface of the thigh in the direction caudally from small incision. By means of the trocar soft tissues are separated from the superficial fascia and a working tunnel is created. Then optical system is introduced and gas (CO2) is pushed in. Under the guidance of the videoscopic system another two small incision are done, one medially one laterally. By means of the knife blade and arthroscopic scissors the superficial fascia is divided and musculotendinous junction of gracilis and semitendinosus is found and muscular recession is done. The aponeurosis of semi-membranosus is isolated and transversely cut. When necessary, from second mini-incision the aponeurosis of biceps femoris is isolated and cut. Operation method was prepared on a cadaver study, concerning the learning curve, for the operation were selected patients with only moderate flexion contracture, Bleck angle between 50–60°.
Results: In 5 operated legs videoscopic tenotomy resulted in full correction of fixed flexion. Small incisions healed uneventfully. No vascular or neurological complications were registered.
Discussion: Videoscopic technique firstly was used in our institution for correction of fixed equinus in CP patients. Concerning good results and acquired operation technique, obtained experience was used for correction of fixed flexion contracture.
Conclusion: Videoscopic correction of fixed knee flexion in CP seems to be a safe and reliable operation method.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
