Clinical and radiological assessment of lumbopelvic region to find out hamstring versus iliopsoas contracture or both in spastic cerebral palsy

Introduction
In cerebral palsy, hamstring contracture is the most prevalent issue. Knee flexion contractures follow if treatment is not received. A typical issue with diplegic cerebral palsy is hamstring tightness, which can lead to a crouching gait.
Aim
To evaluate the hamstring contracture through clinical and radiological assessment of lumbopelvic region.
Patients and methods
This descriptive cross-sectional study design included 30 patients with true hamstring tightness. Every patient underwent the following procedures: a history was obtained; a local clinical examination; an observational gait assessment; an evaluation of gross motor functions; and a radiological assessment that included obtaining plain radiographs of the pelvis and lumbar spine.
Results
Two thirds of the cases had growth motor function (GMF) III, and the other third had GMF Ⅱ, and that the most common gait was crutch gait (36.7%), followed by jump gait (33.3%), then equines gait (16.7%) and only four (13.3%) cases had normal gait. The vast majority of the cases had pelvic tilt (anterior in 60% of the cases and posterior in 13.3% of them) while only eight (26.7%) cases were normal with no tilt. And most of the cases (60%) had decreased sacro-femoral angle, and another four (13.3%) cases had decreased sacro-femoral angle. Only eight (26.7%) cases of the cases were normal. Two thirds of the cases had abnormal lumbo-pelvic alignment (hyperlordotic in 16 cases; 53.3% and kyphotic in four cases; 13.3%). More than half of the cases had positive shift (53.3%), more than half of the cases had positive Thomas test, and all of the included cases had positive popliteal angle.
Conclusion
The majority of patients seem to be tight, and surgeons need to exercise caution to avoid overextending the hamstrings in order to prevent an increased anterior pelvic tilt.