Skip Navigation LinksHome > July/August 2010 - Volume 30 - Issue 5 > Achilles Tendon Length and Medial Gastrocnemius Architecture...
Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0b013e3181e00c80
Cerebral Palsy

Achilles Tendon Length and Medial Gastrocnemius Architecture in Children With Cerebral Palsy and Equinus Gait

Wren, Tishya A. L. PhD* † ‡ § ∥; Cheatwood, Allison P. MS* §; Rethlefsen, Susan A. PT*; Hara, Reiko MA*; Perez, Francisco J. BA; Kay, Robert M. MD* ‡

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Background: The aim of this study was to examine both the tendon and muscle components of the medial gastrocnemius muscle-tendon unit in children with cerebral palsy (CP) and equinus gait, with or without contracture. We also examined a small number of children who had undergone prior surgical lengthening of the triceps surae to address equinus contracture.

Methods: Ultrasound was used to measure Achilles tendon length and muscle-tendon architectural parameters in children of ages 5 to 12 years. Muscle and tendon parameters were compared among 4 groups: Control group (N=40 limbs from 21 typically developing children), Static Equinus group (N=23 limbs from 15 children with CP and equinus contracture), Dynamic Equinus group (N=12 limbs from 7 children with CP and equinus gait without contracture), and Prior Surgery group (N=10 limbs from 6 children with CP who had prior gastrocnemius recession or tendo-achilles lengthening). The groups were compared using analysis of variance and Scheffe post hoc tests.

Results: The CP groups had longer Achilles tendons and shorter muscle bellies than the Control group (P<0.001). Normalized tendon length was also longer in the Prior Surgery group compared with the Static Equinus group (P<0.001). The Prior Surgery group had larger pennation angles than the CP groups (P≤0.009) and tended to have shorter muscle fascicle lengths (P≤0.005 compared with Control and Static Equinus, P=0.08 compared with Dynamic Equinus). Similar results were observed for pennation angles and normalized muscle fascicle lengths throughout the range of motion.

Conclusions: Children with spastic CP and equinus gait have longer-than-normal Achilles tendons and shorter-than-normal muscle bellies. These characteristics are observed even in children with dynamic equinus, before contracture has developed. Surgery further lengthens the tendon, restoring dorsiflexion but not normal muscle-tendon architecture. These architectural features likely affect function, possibly contributing to functional deficits such as plantarflexor weakness after surgery.

Level of Evidence: Level II, prospective comparative study.

© 2010 Lippincott Williams & Wilkins, Inc.

The Pediatric Orthopaedic Society of North America (POSNA)
is a group of healthcare professionals, primarily pediatric orthopaedic surgeons, dedicated to advancing musculoskeletal care of children and adolescents. JPO is our official member journal. 
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