Background: This study aims to investigate changes in femoral head anteversion, popliteal angle, and the effect of internal hamstring lengthening on hip rotation in children with CP undergoing surgical and non-surgical interventions.
Methods: This retrospective cross-sectional study included 30 children aged 5-12 years with CP and knee contracture. Patients were divided into two groups: 15 with severe contracture and popliteal angle >70° underwent surgery, and 15 with moderate contracture and popliteal angle 30-70° received non-surgical treatment (botulinum toxin injection).
Results: In the surgical group, internal hip rotation decreased by 15°, popliteal angle by 48°, knee extension by 13°, and femoral head anteversion by 10°, while external hip rotation increased by 18°. In the non-surgical group, internal hip rotation decreased by 10°, popliteal angle by 19°, knee extension by 8°, and femoral head anteversion by 19°, while external hip rotation increased by 10° (All p-values=0.001)
Conclusions: Internal hamstring lengthening, both surgical and non-surgical (botulinum toxin injection), improves movement (hip rotation and gait pattern) in children with CP, both surgical and non-surgical medial hamstring lengthening yield significant within-group improvements in hip rotation dynamics, popliteal angles, and knee extension deficits within their respective severity cohorts. Rather than comparing superiority, clinical decision-making should be guided by baseline contracture severity, with surgery reserved for severe structural contractures and botulinum toxin type A utilized for moderate spasticity for children with CP.