{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T18:02:37Z","timestamp":1785175357130,"version":"3.55.0"},"reference-count":10,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: The timing and efficacy of Achilles tendon lengthening (ATL) in Duchenne muscular dystrophy (DMD) remain controversial because indiscriminate surgery can accelerate ambulation loss. Case Description: This report presents a 5-year longitudinal comparative analysis (2021\u20132026) of monozygotic twins with identical genetic backgrounds (DMD exon 30\u201343 deletion) who received comparable rehabilitation and pharmacological management, including concurrent gene therapy in 2025. Twin A was managed conservatively with orthosis and subsequent serial casting for progressive equinus contracture, whereas Twin B underwent early bilateral ATL during transition to the non-ambulatory phase. Despite a temporary postoperative decline, Twin B demonstrated a more stable longitudinal motor trajectory, outperforming Twin A in gross motor function (Gross Motor Function Measure-88: 38.60% vs. 32.85% in 2026) by preserving residual standing and crawling dimensions. Longitudinal KIDSCREEN-52 assessments revealed a clinically meaningful improvement in psychological well-being in Twin B (+10.9 points) relative to Twin A. Conclusions: This single-pair twin case serves as a hypothesis-generating observation, highlighting a potential longitudinal association between early surgery and attenuated progressive motor decline within a multi-disciplinary care regimen. Given highly variable psychosocial outcomes, these trends cannot be directly attributed to surgery alone. When evaluating such orthopedic interventions, clinical decisions may benefit from looking beyond immediate gait metrics toward broader, long-term functional trends, though the relative contributions of concurrent therapies remain to be elucidated.<\/jats:p>","DOI":"10.3390\/children13080988","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:16:34Z","timestamp":1785172594000},"page":"988","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Functional Trajectory and Quality of Life Divergence Following Surgical Versus Conservative Management of Achilles Tendon Contracture in Monozygotic Twins with Duchenne Muscular Dystrophy: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"given":"Taekyung","family":"Lee","sequence":"first","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihyun","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeonsu","family":"Oh","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5625-3013","authenticated-orcid":false,"given":"Han Eol","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7153-4937","authenticated-orcid":false,"given":"Dong-wook","family":"Rha","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1597-4137","authenticated-orcid":false,"given":"Juntaek","family":"Hong","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S1474-4422(09)70271-6","article-title":"Diagnosis and management of Duchenne muscular dystrophy, part 1: Diagnosis, and pharmacological and psychosocial management","volume":"9","author":"Bushby","year":"2010","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.clinbiomech.2016.04.005","article-title":"Beneficial effects of ankle\u2013foot orthosis daytime use on the gait of Duchenne muscular dystrophy patients","volume":"35","author":"Figueiredo","year":"2016","journal-title":"Clin. Biomech."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S1474-4422(18)30025-5","article-title":"Diagnosis and management of Duchenne muscular dystrophy, part 2: Respiratory, cardiac, bone health, and orthopaedic management","volume":"17","author":"Birnkrant","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.pmr.2012.06.009","article-title":"Prevention and management of limb contractures in neuromuscular diseases","volume":"23","author":"Skalsky","year":"2012","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"446","DOI":"10.3346\/jkms.2007.22.3.446","article-title":"The KIDSCREEN-52 quality of life measure for children and adolescents (KIDSCREEN-52-HRQOL): Reliability and validity of the Korean version","volume":"22","author":"Hong","year":"2007","journal-title":"J. Korean Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1586\/14737167.5.3.353","article-title":"KIDSCREEN-52 quality-of-life measure for children and adolescents","volume":"5","author":"Gosch","year":"2005","journal-title":"Expert Rev. Pharmacoecon. Outcomes Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lejman, J., Pytlak, M., Danielewicz, A., Rutz, E., Latalski, M., and Lejman, M. (2026). Molecular Insights and Orthopedic Management in Muscular Dystrophies: A Comprehensive Review. Int. J. Mol. Sci., 27.","DOI":"10.3390\/ijms27041896"},{"key":"ref_8","first-page":"21","article-title":"Surgical treatment of Duchenne muscular dystrophy patients in Germany: The present situation","volume":"31","author":"Forst","year":"2012","journal-title":"Acta Myol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1542\/peds.2018-0333J","article-title":"Orthopedic and surgical management of the patient with Duchenne muscular dystrophy","volume":"142","author":"Apkon","year":"2018","journal-title":"Pediatrics"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Moses, M.O., Onuegbu, N.F., Deku, P.D.-G., Nyarko, M.A., Owusu, L.B., Emikpe, A.O., John, E.B., Soangra, R., Yifieyeh, A.C., and Titiloye, N.A. (2025). Joint Angular Kinematics and Gross Motor Function in Typically Developing Healthy Children. Children, 12.","DOI":"10.3390\/children12030280"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/988\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:18:13Z","timestamp":1785172693000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/988"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,25]]},"references-count":10,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["children13080988"],"URL":"https:\/\/doi.org\/10.3390\/children13080988","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,25]]}}}