Hamstring lengthening surgery

Why does my child need hamstring lengthening surgery?

Hamstring lengthening surgery can help get your child’s knees straighter. When the hamstring muscles at the back of the leg become tight children can lose the ability to fully straighten their knees.

This tightness can develop due to overactive muscles, weak muscles and reduced mobility relating to your child’s condition. When this happens it can lead to a number of problems.

For children who are able to walk, either independently or with help, being unable to straighten their knees makes them stand in a crouched position meaning walking is much more difficult and tiring.

For children who are unable to walk, or have great difficulty walking, this tightness can develop much quicker due to spending more time sitting. Once children lose the ability to straighten their knees they are more likely to rest in positions that put their hips at increased risk of displacing. Hip displacement is when the ball of the hip joint moves from under the socket. They may also have more difficulty with standing transfers and accessing their standing frame.

How can surgery help?

An operation to lengthen these muscles can help your child get their legs straighter. It can make it easier for your child to sit, stand and move. It may also make activities like washing and dressing more manageable.

There are risks, as with any operation and the surgeons will go through these with you. It may not be possible to get the knees fully straight with this operation.

Your orthopaedic team will discuss the options and what is best for your child and family. You will have the opportunity to ask any questions you may have.

What does the surgery involve?

The operation to lengthen the hamstring muscles (often called ‘hamstring release’) is done under a general anaesthetic where your child is asleep. After the operation children usually need to stay in hospital overnight, the length of their stay in hospital will depend on how comfortable they are after the operation.

What happens during the operation?

The operation is done through a small cut in the skin. Through this small opening, little cuts are made into the tight muscles so they can be stretched and made longer.

What else happens in hospital?

Controlling pain

Children may have some pain and experience muscle spasms after the operation. If that is the case your child will be given medication to help control this.

Therapy

After muscle lengthening surgery it is important for the muscles to heal in their new lengthened position. The therapy team will see your child on the ward after their operation.

They will go through exercises, positive positions and things you can do to help your child get the most from their surgery. After the operation exercises will need to be carried out a minimum of 3 times a day. Your local physiotherapist will guide your child’s rehab journey however it is your responsibility to ensure they complete the necessary exercises.

Your child will be given leg gaiters or braces to help keep their legs straight to promote healing in a positive position.

These should be worn at all times for the first 2 weeks then dropping to overnight and whenever convenient. 1 hour a day must be spent in long sitting to get the best stretch. Your child will need elevating leg rests for their wheelchair to allow them to sit with their legs straight at all times. The therapists at the hospital will speak to your local therapists to arrange this. If their wheelchair will not accommodate these leg rests we will look at building up the footplates to support their legs in the required position.

Your child will be able to put all their weight through their legs after the operation, unless they have had bony surgery at the same time. They will be encouraged to stand and walk as they are able whilst wearing their gaiters.

The therapy team at the hospital will speak to your child’s local physiotherapist when they’re discharged. They will ask that they arrange to see your child when they are home and pass on any important information. Ensure you speak to your local physiotherapist and school before your child returns to school.

Follow-up after the operation

An appointment will be arranged for you to come back to hospital for review. The amount of movement in your child’s knees and hips will be looked at.

What happens next?

You should continue to support your child with exercises and positioning advice provided by your child’s therapists. Your child’s ability to walk, stand and move will be monitored as well as their muscle lengths.