Combined Gastrocnemius Release with Gracilis and Toe Flexor Release Offers a Targeted Multi-Level Approach within Single Event Multi-Level Surgery (SEMLS) for Correcting Unilateral Lower Limb Deformities in Spastic Hemiplegic Cerebral Palsy
Author : Dr. Santoshkumar Hankare, Dr. Saurabh Fate, Dr. Naved Ansari, Dr. Abhishek Ganacharya, Dr. Trunay Kongalwar, Dr. Sharabanti Saha and Dr. Mussaveer Pathan
Abstract :
Background: Spastic hemiplegic cerebral palsy often causes multi-level lower limb deformities, impairing gait and mobility. Single-level surgeries yield suboptimal results due to persistent spasticity elsewhere.
Case Series: We report outcomes in 15 ambulatory patients (aged 4–18 years, GMFCS I–III) undergoing combined gastrocnemius release, gracilis release, and toe flexor lengthening as part of SEMLS in spastic hemiplegic cerebral palsy.
Results: Ankle dorsiflexion improved from −10° to +10° (p<0.05), knee flexion reduced from 24° to 6° (p<0.05), and toe clawing resolved in all. Gait symmetry, step length, and GMFCS levels enhanced; complications were minimal (overcorrection in 1, weakness in 1).
Conclusion: This multi-level soft tissue release effectively restores biomechanics with low recurrence, supporting SEMLS principles. Gastrocnemius, gracilis, and toe flexor release is a safe and effective SEMLS strategy significantly improving gait, functional mobility, and quality of life.
Keywords :
Cerebral palsy, spastic hemiplegia, SEMLS, gastrocnemius release, gracilis release, toe flexor.
