Tendon Lengthening Following SDR
For appointments call 314.454.KIDS (5437) or 800.678.KIDS (5437)
|Download our Tendon Lengthening Following SDR Brochure|
Patients who undergo selective dorsal rhizotomy (SDR) surgery at St. Louis Children’s Hospital’s Center for Cerebral Palsy Spasticity often need an additional surgical procedure for muscle/tendon lengthening to relieve contracture (limited motion) in their joints.
Matthew Dobbs, MD, a Washington University orthopedic surgeon at St. Louis Children’s Hospital, uses a minimally-invasive surgical procedure to accomplish the lengthening. This allows the muscle to return to its normal length and the joint to straighten, and is one step in helping children walk with their heels on the floor and knees straight.
Unlike other surgical approaches to tendon lengthening, the minimally-invasive procedure allows for a quicker recovery and in most cases, children start therapy the next day. Depending on the muscle or tendon lengthened the child may or may not require casting. Achilles tendon lengthening does require below the knee leg casts for a short time, usually 2-3 weeks. These casts allow for limited ambulation and continued therapy. Hamstring and gastroc lengthening’s do not require casts.
Muscle/Tendon Lengthening Procedure
The surgery is accomplished using a minimally invasive approach for controlled lengthening. The hamstring, gastroc and heel cord (Achilles tendon) are the most common structures that need lengthening. The procedure is performed in an operating room under general anesthesia. A minimally invasive feathering technique is used to lengthen the tendon as opposed to the traditional method of cutting and reattaching the tendon.
|Dr. Matthew Dobbs discusses the benefits of a minimally-invasive surgical procedure for tendon lengthening.|
Patients spend one night in the hospital to monitor any postop pain and nausea, and start physical therapy the day after surgery. Your child will be fitted for specially-designed braces to wear post- lengthening to help with standing and walking.
Children who have the tendo Achilles lengthening will be in short casts for several weeks after surgery. The casts may be split in the OR to allow for any swelling that may occur and over wrapped with ace wraps. You will have an appointment for cast removal and brace placement 2-3 weeks after surgery at St. Louis Children's Hospital, or for your convenience the casts can be removed at a facility nearer your home. We can provide you with a note (prescription) to have them removed locally and order the braces to be delivered to your home. After cast removal the children must wear nighttime ankle stretching splints and daytime solid AFOs (see bracing below).
Children who undergo either the selective dorsal rhizotomy surgery alone or in combination with follow-up tendon lengthening may experience rapid and dramatic changes in their walking. To enhance their recovery and improvement, we recommend physical therapy (PT) four to five times a week for the first six months; three to four times per week for the next six months; and two to four times a week for the following year or longer. The intense PT schedule helps children maintain their motion and their maximum strength and walking potential.
A specially-trained pediatric physical therapist will work with your child while they are at the hospital, and create an individualized plan to continue the therapy once they return home.
Bracing is an important part in maintaining the correction achieved with surgery. Dr. Park and Dr. Dobbs prefer the cascade bracing system that consists of turbo both tall and short bracing. We can provide a prescription for these to be measured prior to the procedure. Please contact our office if you did not receive a prescription or have bracing measured prior to scheduling the procedure.
After heel cord/gastroc lengthening surgery, your child will wear an ankle foot orthosis, or AFO, to assist with walking. As your child gets stronger, he or she may transition to a less restrictive splint such as a SMO or DAFO. Physical therapy will assist in the timing to decrease the brace. The night time dorsiflexion stretching splints need to be worn until the patient grows out of them. Daytime bracing is typically worn for 6-8 weeks after surgery and then wean to smaller SMO brace for several months. The night time braces are worn as long as possible-often a year or more as the patient is at risk for reoccurrence with growth.
After hamstring lengthening surgery, your child will wear nighttime knee splints to maintain correction.
Eligibility for Surgery
Matthew Dobbs, MD, pediatric orthopedic surgeon, and T.S. Park, MD, pediatric neurosurgeon, will evaluate a patient’s eligibility for the tendon lengthening surgery. If your child is a candidate for tendon lengthening, the procedure is typically performed 2-8 weeks after SDR surgery.
For more information about selective dorsal rhizotomy surgery or minimally invasive tendon lengthening surgery at St. Louis Children’s Hospital, contact us at 314.454.KIDS (5437) or 800.678.KIDS (5437).