, Volume 6, Issue 6, pp 515-516
Date: 11 Oct 2012

Response to letter re: Comparison of hamstring lengthening with hamstring lengthening plus transfer for treatment of flexed knee gait in ambulatory patients with cerebral palsy

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We thank the correspondent for his interest and thoughtful questions regarding our paper. We think the two biggest problems following hamstring surgery for flexed knee gait are: (1) achieving adequate correction and (2) maintaining correction over the subsequent years.

In order to maximize correction, we maintain patients in solid ankle–foot orthoses (AFOs) for daytime use and ground reaction AFOs for those with more severe involvement, the latter usually temporarily, since the patients frequently find them too constraining; as well as nighttime knee immobilizers for 6 months postoperatively.

We have not found any evidence of “overdose” in the patients in this series. All patients in the hamstring transfer plus lengthening (HST) group had lengthening of the semimembranosus and biceps, along with transfer of the gracilis and semitendinosus, while in a few patients in the hamstring lengthening alone (HSL) group, the biceps was left intact. Knee recurvatum did not occur in any patient in th