ArticleJournal of children's orthopaedics2020
Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: a Delphi consensus study.
Article in Journal of children's orthopaedics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- Outcomes of percutaneous musculotendinous lengthening in children with Cerebral Palsy: a systematic review.Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo · 2026Pooled it
- Gastrocsoleus lengthening in combination with tibialis anterior tendon shortening for equinus deformity in children with cerebral palsy: a systematic review.Systematic reviews · 2025Pooled it
- Percutaneous tendon lengthening and selective percutaneous myofascial lengthening in children with cerebral palsy: Establishing surgical indications using the Delphi method.Journal of children's orthopaedics · 2026Article
- Article
- Impact of single-event multilevel surgery on gait efficiency in children with cerebral palsy: a retrospective study.European journal of physical and rehabilitation medicine · 2025Article
- Reinforced lengthening Achilles tendon Z-plasty - ex vivo assessment of biomechanical augmentation with surgical-fiberlock technology.International orthopaedics · 2025Article
- Development of ankle and knee range of motion after isolated gastrocsoleus lengthening in children with cerebral palsy: a register-based longitudinal cohort study.Acta orthopaedica · 2025Article
- Quantifying the effects of achilles tendon lengthening surgery: An intraoperative approach.Frontiers in physiology · 2023Article
- Distal femoral extension osteotomy and patellar tendon advancement or shortening in ambulatory children with cerebral palsy: A modified Delphi consensus study and literature review.Journal of children's orthopaedics · 2022Article
- Defining Equinus Foot in Cerebral Palsy.Children (Basel, Switzerland) · 2022Article
- Assessment of foot alignment and function for ambulatory children with cerebral palsy: Results of a modified Delphi technique consensus study.Journal of children's orthopaedics · 2022Article
- Ankle Dorsiflexor Function after Gastrocsoleus Lengthening in Children with Cerebral Palsy: A Literature Review.Medicina (Kaunas, Lithuania) · 2022Review
- Anterior distal femoral hemiepiphysiodesis in children with cerebral palsy: Establishing surgical indications and techniques using the modified Delphi method and literature review.Journal of children's orthopaedics · 2022Article
- Finding consensus for hamstring surgery in ambulatory children with cerebral palsy using the Delphi method.Journal of children's orthopaedics · 2022Article
- Split anterior tibialis tendon transfer to peroneus brevis for spastic equinovarus in children with hemiplegia.Journal of children's orthopaedics · 2021Article
- Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project.Journal of children's orthopaedics · 2021Article
- Three-Dimensional Gait Analysis in Children Undergoing Gastrocsoleus Lengthening for Equinus Secondary to Cerebral Palsy.Medicina (Kaunas, Lithuania) · 2021Review
Corrections and comments
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Authors and funding
17 authors at 15 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeEquinus is the most common deformity in cerebral palsy (CP) and gastrocsoleus lengthening (GSL) is the most commonly performed surgery to improve gait and function in ambulatory children with CP. Substantial variation exists in the indications for GSL and surgical technique. The purpose of this study was to review surgical anatomy and biomechanics of the gastrocsoleus and to utilize expert orthopaedic opinion through a Delphi technique to establish consensus for surgical indications for GSL in ambulatory children with CP.
methodsA 17-member panel, of Fellowship-trained paediatric orthopaedic surgeons, each with at least 9 years of clinical post-training experience in the surgical management of children with CP, was established. Consensus for the surgical indications for GSL was achieved through a standardized, iterative Delphi process.
resultsConsensus was reached to support conservative Zone 1 surgery in diplegia and Zone 3 surgery (lengthening of the Achilles tendon) was contraindicated. Zone 2 or Zone 3 surgery reached general agreement as a choice in hemiplegia and under-correction was preferred to any degree of overcorrection. Agreement was reached that the optimum age for GSL surgery was 6 years to 10 years and should be avoided in children aged under 4 years. Physical examination measures with the child awake and under anaesthesia were important in decision making. Gait analysis was supported both for decision making and for assessing outcomes, in combination with patient reported outcomes (PROMS).
conclusionsThe results from this study may encourage informed practice evaluation, reduce practice variability, improve clinical outcomes and point to questions for further research. LEVEL OF EVIDENCE: V.
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