Herbert Capsuloplasty and Burnei Tenomyoplasty for the Correction of Genu Flexum in Cerebral Palsy Arthrogryposis and Posttraumatic

Introduction: Studies of gait dynamics revealed the complexmotions that the knee must undergo in sync with the hip andankle, in both the swing and support phase of walking. If thesemotions are restricted, usually as a consequence of cerebralpalsy or arthrogryposis, normal gait is hindered; the patientmay be able to walk for very short distances or, eventually, notat all. Children with knee extension limited by 10 - 30 degrees,especially those with cerebral palsy, exhibit a stancecompatible with walking. Walking is difficult and the gaitpattern, “crouch gait”, is considered typical for this degree oflimitation.Aim: This paper is meant as an update regarding the usefulnessof Herbert knee capsuloplasty, conceived in 1938 andintroduced in Romania in 1956 by Clement Baciu, and Burneidistal medial hamstring tenomyoplasty, invented in 1993.Materials and methods: Herbert knee capsuloplasty, althoughinitially intended for ailments other than spasticity or arthrogryposis,became known, in time, as a useful operation forspastic genu flexum with a 15 to 30 degree limitation ofextension. Severing the posterior cruciate ligament (PCL) inchildren less than 10 years old often results in genu recurvatumor joint instability. In order to avoid these complications, PCLtransection has been phased out and our clinic started touse, preferentially for spastic genu flexum rather than arthrogryposis,the Burnei tenomyoplasty. When applied in the sameoperative session, the two techniques complement each otherand act in synergy.Results: Herbert capsuloplasty can achieve only partialcorrection of genu flexum ranging between 30 and 60 degreesof extension deficit. Full extension is opposed by the PCL,contracture of the hamstrings and vascular retraction. Burneitenomyoplasty used by itself is useful for genu flexum with lessthan 30 degrees of extension deficit. For children with 30 to60 degrees of knee extension deficit, combining the Herbertand Burnei procedures achieves the best results.Conclusions: The simultaneous application of Herbert capsuloplastyand Burnei tenomyoplasty allows for the correction ofstiff genu flexum and enables the patient to resume walking,with or without support. This course of treatment also avoidsthe progression of genu flexum beyond 60 degrees, whichwould require an osteotomy. This combined procedure avoidsthe cartilage lesions which may develop when patients with 30- 60 degree genu flexum undergo Herbert capsuloplasty alone.Not in the least, the risk of postoperative knee dislocation issignificantly reduced.

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