{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T09:05:20Z","timestamp":1789290320607,"version":"build-2803163510"},"reference-count":0,"publisher":"Indian Orthopaedic Research Group","issue":"8","content-domain":{"domain":["jocr.co.in"],"crossmark-restriction":true},"short-container-title":["Jocr"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Introduction: Spastic hemiplegic cerebral palsy (CP) often causes multi-level lower limb deformities, impairing gait and mobility. Single-level surgeries yield suboptimal results due to persistent spasticity elsewhere.\n\nCase Series: We report outcomes in 15 ambulatory patients (aged 4\u201318 years, gross motor function classification system [GMFCS] I\u2013III) undergoing combined gastrocnemius release, gracilis release, and toe flexor lengthening as part of single-event multi-level surgery (SEMLS) in spastic hemiplegic CP.\n\nResults: Ankle dorsiflexion improved from -10\u00b0 to +10\u00b0 (P &lt; 0.05), knee flexion reduced from 24\u00b0 to 6\u00b0 (P &lt; 0.05), and toe clawing resolved in all. Gait symmetry, step length, and GMFCS levels were enhanced; complications were minimal (overcorrection in 1, weakness in 1).\n\nConclusion: This multi-level soft-tissue release effectively restores biomechanics with low recurrence, supporting SEMLS principles. Gastrocnemius, gracilis, and toe flexor release are safe and effective SEMLS strategies significantly improving gait, functional mobility, and quality of life.\n\nKeywords: Cerebral palsy, spastic hemiplegia, single-event multi-level surgery, gastrocnemius release, gracilis release, toe flexor.<\/jats:p>","DOI":"10.13107\/jocr.2026.v16.i08.7890","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T10:05:46Z","timestamp":1786183546000},"page":"334-341","update-policy":"https:\/\/doi.org\/10.13107\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined Gastrocnemius Release with Gracilis and Toe Flexor Release Offers a Targeted Multi-Level Approach within Single Event Multi-Level Surgery for Correcting Unilateral Lower Limb Deformities in Spastic Hemiplegic Cerebral Palsy"],"prefix":"10.13107","volume":"16","author":[{"given":"Santoshkumar J.","family":"Hankare","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurabh Gajanan","family":"Fate","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek Milind","family":"Ganacharya","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal Bhaskarrao","family":"Karpe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trunay Narendra","family":"Kongalwar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navnath Babasaheb","family":"Ghule","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5271","published-online":{"date-parts":[[2026]]},"container-title":["Journal of Orthopaedic Case Reports"],"original-title":[],"deposited":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T08:45:27Z","timestamp":1789289127000},"score":1,"resource":{"primary":{"URL":"https:\/\/jocr.co.in\/wp\/2026\/08\/combined-gastrocnemius-release-with-gracilis-and-toe-flexor-release-offers-a-targeted-multi-level-approach-within-single-event-multi-level-surgery-for-correcting-unilateral-lower-limb-deformities-in-s\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.13107\/jocr.2026.v16.i08.7890","relation":{},"ISSN":["2321-3817"],"issn-type":[{"value":"2321-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"Research Article","name":"content_type","label":"Content Type"},{"value":"Yes","name":"crosschecked","label":"CrossChecked"},{"value":"Yes","name":"peer_reviewed","label":"Peer Reviewed"},{"value":"10.13107\/jocr.2026.v16.i08.7890","name":"published","label":"Published"},{"value":"Creative Commons Attribution","name":"license","label":"License","explanation":{"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},"group":{"name":"rights","label":"Rights"}}]}}