{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T05:15:16Z","timestamp":1792300516314,"version":"4.4.0"},"reference-count":22,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"2","license":[{"start":{"date-parts":[[2006,2,1]],"date-time":"2006-02-01T00:00:00Z","timestamp":1138752000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2006,2]]},"abstract":"<jats:p> Between July 2000 and April 2004, 19 patients with bilateral spastic cerebral palsy who required an assistive device to walk had combined lengthening-transfer of the medial hamstrings as part of multilevel surgery. A standardised physical examination, measurement of the Functional Mobility Scale score and video or instrumented gait analysis were performed pre- and post-operatively. Static parameters (popliteal angle, flexion deformity of the knee) and sagittal knee kinematic parameters (knee flexion at initial contact, minimum knee flexion during stance, mean knee flexion during stance) were recorded. The mean length of follow-up was 25 months (14 to 45). <\/jats:p><jats:p> Statistically significant improvements in static and dynamic outcome parameters were found, corresponding to improvements in gait and functional mobility as determined by the Functional Mobility Scale. Mild hyperextension of the knee during gait developed in two patients and was controlled by adjustment of their ankle-foot orthosis. Residual flexion deformity &gt; 10\u00b0 occurred in both knees of one patient and was treated by anterior distal femoral physeal stapling. Two children also showed an improvement of one level in the Gross Motor Function Classification System. <\/jats:p>","DOI":"10.1302\/0301-620x.88b2.16797","type":"journal-article","created":{"date-parts":[[2006,1,24]],"date-time":"2006-01-24T18:48:46Z","timestamp":1138128526000},"page":"248-254","source":"Crossref","is-referenced-by-count":48,"title":["Lengthening and transfer of hamstrings for a flexion deformity of the knee in children with bilateral cerebral palsy"],"prefix":"10.1302","volume":"88-B","author":[{"given":"F. Y. P.","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, The Royal Children\u2019s Hospital, Flemington Road, Parkville, Victoria 3052, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Selber","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Royal Children\u2019s Hospital, Flemington Road, Parkville, Victoria 3052, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. R.","family":"Nattrass","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Royal Children\u2019s Hospital, Flemington Road, Parkville, Victoria 3052, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. R.","family":"Harvey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Royal Children\u2019s Hospital, Flemington Road, Parkville, Victoria 3052, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine Monash University, Alfred Hospital, Prahran 3004, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. K.","family":"Graham","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Melbourne and Murdoch Children\u2019s Research Institute, Hugh Williamson Gait Laboratory, Flemington Road, Parkville, Victoria 3052, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"R1","unstructured":"Graham HK. Mechanisms of deformity. In: Scrutton D, Damiano D, Mayston M, eds. Clinics in developmental medicine No 161: management of the motor disorders of children with cerebral palsy, Second ed. London: MacKeith Press, 2004:105\u201329."},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1997.tb07414.x"},{"key":"R3","doi-asserted-by":"crossref","unstructured":"Eggers GW. Transplantation of hamstring tendons to femoral condyles in order to improve hip extension and to decrease knee flexion in cerebral spastic paralysis. J Bone Joint Surg [Am] 1952;34-A:827\u201330.","DOI":"10.2106\/00004623-195234040-00010"},{"key":"R4","doi-asserted-by":"crossref","unstructured":"Keats S, Kambin P. An evaluation of surgery for the correction of knee flexion con-tracture in children with cerebral spastic paralysis. 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Saunders Co. 2002:1159\u201373."},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1054\/cuor.2003.0328"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-195032030-00022"},{"key":"R13","doi-asserted-by":"crossref","unstructured":"Keenan WN, Rodda J, Wolfe R, et al. The static examination of children and young adults with cerebral palsy in the gait analysis laboratory: technique and observer agreement. J Pediatr Orthop 2004;13:1\u20138.","DOI":"10.1097\/00009957-200401000-00001"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.86B2.13878"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200111000-00020"},{"key":"R16","unstructured":"Ferraretto I, Machado PO, Filho EL, Selber P. Preliminary results of patellar tendon shortening as a salvage procedure for crouch gait in cerebral palsy [abstract]. Paediatric Orthopaedic Society North America 2000."},{"key":"R17","unstructured":"Novacheck TF. Diplegia and quadriplegia: pathology and treatment. In: Gage JR, ed. Clinics in developmental medicine No 164\u2013165: the treatment of gait problems in cerebral palsy. London: MacKeith Press, 2004:345\u201381."},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199311000-00006"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100140123"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100150419"},{"key":"R21","unstructured":"Miller F, Dabney KW, Rang M. Complications in cerebral palsy. In: Epps CHJB, Bowen JR, eds. Complications in pediatric orthopaedic surgery. Philadelphia: J.B. Lippincott Co. 1995:477\u2013544."},{"key":"R22","doi-asserted-by":"crossref","unstructured":"Metaxiotis D, Wolf S, Doederlein L. Conversion of biarticular to monoarticular muscles as a component of multilevel surgery in spastic diplegia. 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