The Role of Knee Flexors Hypertonia in the Decision-Making of Hamstring Lengthening Surgery for Individuals with Cerebral Palsy
Bibliographic record
Abstract
Popliteal angle (PA) and the knee position at the end of the swing phase during walking (Kts) are considered criteria for treatment selection and outcome prediction of hamstring lengthening surgery in individuals with cerebral palsy (CP). However, the relationships among Kts, PA, and hypertonia are not clear. This study aimed to determine whether hamstrings hypertonia affects the values of PA and Kts, and how it may affect the hamstring lengthening decision for CP. One hundred and twenty-six subjects with CP (male = 72, female = 54; age = 11.1 ± 3.9 years) underwent gait analysis and examination of hamstrings hypertonia (Tardieu scale) and length (PA). We found that Kts increased with PA (Kts = 5.00 + 0.31 × PA (r = 0.39; p < 0.001)). Every 10° change of PA leads to 3° improvement of knee position in walking. Kts were larger (p < 0.001) in the limbs with (20.40 ± 11.27°) than without (15.60 ± 9.99°) knee flexors hypertonia (Tardieu slow); and were larger (p < 0.001) in the limbs with (20.39 ± 11.01°) than without (14.85 ± 9.89°) knee flexors hypertonia (Tardieu fast). PAs were larger (p < 0.05) in the limbs with (42.81 ± 12.66°) than without (38.96 ± 14.38°) hypertonia (Tardieu fast). Kts = 13.93° and PA = 30° were cutoff values of the presence of hypertonia with sensitivities of 75.0% and 89.1%, respectively. Kts increased with the PA in ambulatory CP. It is estimated that pathological increase of Kts occurs at PA ≥ 40°. The hypertonia of knee flexors affected Kts and PA. The presence of knee flexors hypertonia should be considered in the decision-making of hamstring lengthening for individuals with CP if Kts ≥ 13.93° and PA ≥ 30°.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".