Tendon Surgery in Cerebral Palsy
In children with cerebral palsy, tight muscles can make walking and daily care harder. Tendon surgery aims to improve movement and balance in suitable children.
Cerebral palsy (CP) is a group of movement and posture disorders caused by damage to the developing brain before or during birth or in early infancy. The brain damage does not progress, but as the child grows, muscle stiffness (spasticity), tightness and joint deformities can develop. Orthopaedic treatment aims to reduce these secondary problems and improve the child’s mobility and quality of life.
Common problems
- Toe walking caused by a tight Achilles tendon (equinus)
- Walking with bent knees due to tight hamstrings (crouch gait)
- Tight muscles pulling the hips inwards and a scissoring gait
- The hip gradually slipping out of the socket (hip subluxation)
- Foot and hand deformities
- Difficulty with sitting, hygiene and care
Assessment
Treatment planning needs paediatric neurology, physiotherapy and orthopaedics working together. Muscle strength, degree of spasticity, joint range of motion and walking are assessed. X-rays and gait analysis are used when needed. The hips in particular are monitored with regular X-rays.
Non-surgical treatment
- Regular physiotherapy and stretching programmes
- Orthoses (especially ankle-foot orthoses)
- Botulinum toxin injections to reduce spasticity
- Serial casting to increase muscle length
Tendon surgery
Surgery is used when muscle tightness does not respond to non-surgical treatment and limits function:
- Tendon lengthening: The Achilles, hamstring or hip adductor tendons are lengthened in a controlled way.
- Tendon transfer: The tendon of an imbalanced muscle is moved to a different point to rebalance the muscles.
- Single-event multilevel surgery: In suitable children, problems at the hip, knee and ankle are corrected in one operation, reducing repeated surgery and rehabilitation periods.
- Bone surgery: Bone correction may be needed for hip displacement or severe deformity.
After surgery
A cast or orthosis is usually worn for a while after surgery. Intensive, regular physiotherapy is essential for the benefit of surgery to appear. Improvements in walking become clear over months.
Goals of treatment
For children with cerebral palsy, treatment goals depend on the child’s level of mobility. For children who walk independently, the aim is a more efficient, balanced and less tiring gait. For those who walk with support, the aim is to preserve and improve walking ability. For children who cannot walk, comfortable sitting, easier care, preventing pain and protecting the hip come first.
Gait analysis
Gait analysis records the child’s walking with cameras and special systems so the movement of each joint can be studied in detail. It helps plan more precisely which muscles are tight, which joints are affected and at which levels surgery is needed. It is also used after surgery to assess the improvement.
The right time for surgery
Doing tendon surgery too early can increase the risk of tightness returning with growth. Operations are therefore usually planned once the child’s walking pattern has matured. Progressive problems such as hip displacement may need earlier intervention. Timing is decided together with the family.
The family’s role
The home programme, use of orthoses and regular physiotherapy are decisive in making the benefits of surgery last. Families are informed in detail about the process before and after surgery and trained in home exercises.
Frequently asked questions
Does surgery cure CP?
No. It does not change the brain damage; it aims to make movement and daily life easier by correcting secondary problems in muscles and joints.
At what age is surgery done?
Timing varies. It is usually planned once the walking pattern has settled and non-surgical treatment is no longer enough.
Why is hip monitoring important?
In children with CP the hip can gradually slip out of the socket, causing pain and sitting problems. Regular X-rays allow early intervention.
Can botulinum toxin replace surgery?
Botulinum toxin can delay surgery by reducing muscle stiffness, especially at a young age. Its effect on fixed muscle shortening is limited, and surgery may be needed.
How long is the cast worn after surgery?
It depends on the procedure; usually a cast for a few weeks followed by an orthosis.
Will my child walk better after surgery?
In suitable children, tendon surgery can make walking more upright, balanced and less tiring. The improvement takes months to show and depends on regular physiotherapy.
Can the tightness come back?
As the child grows, muscles may not lengthen as fast as bones, so tightness can return. Regular stretching, orthoses and follow-up reduce this risk.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.