(in vivo Gastrocnemius Muscle) Tendon Ratio in Patients with Cerebral Palsy

Muhammad Naghman Choudhry1, *, Haris Naseem1, Ihsan Mahmood2, Adeel Aqil3, Tahir Khan4
1 Royal Manchester Children's Hospital, Upper Brook Street, Manchester, M13 9WL, U.K
2 James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, U.K
3 Pinderfields Hospital, Aberford Road, Wakefield,WF1 4DG, U.K
4 Royal National Orthopaedic Hospital and Institute of Orthopaedics, University College London, Brockley Hill, Stanmore,HA7 4LP, U.K

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 1008
Abstract HTML Views: 480
PDF Downloads: 311
ePub Downloads: 280
Total Views/Downloads: 2079
Unique Statistics:

Full-Text HTML Views: 602
Abstract HTML Views: 319
PDF Downloads: 214
ePub Downloads: 208
Total Views/Downloads: 1343

Creative Commons License
© 2017 Choudhry et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Royal Manchester Children's Hospital, Oxford Road,, Manchester, M13 9WL, United Kingdom; Tel: +44 (0)7931146389; E-mails:,



The position of the gastrocnemius tendon in relation to the leg length may be different in children with cerebral palsy as compared to normal children. The palpation of muscle bellies or previous experience of the operating surgeon is employed to place the surgical incision for lengthening of the gastrocnemius aponeurosis. Inaccurate localisation may cause incorrect incisions and a risk of iatrogenic damage to the vital structures (i.e. sural nerve).


The aim of our study is to compare gastrocnemius length in-vivo between paretic and unaffected children and create a formula to localise the muscle–tendon junction accurately.


10 children with di/hemiplegia (range 2-14y) were recruited. None of them had received any conventional medical treatment. An equal number of age/sex matched, typically developing children (range 4-14y) were recruited. Ultrasound scanning of the gastrocnemius muscle at rest was performed to measure the length of gastrocnemius bellies. We also measured the heights and leg lengths in all the children.


The gastrocnemius medial muscles were shorter in Cerebral Palsy children when compared to similar aged normal children. In cerebral palsy children, the gastrocnemius muscle and leg ratio ranged between 35 to 50% (average ratio of 45%).


Using these figures, we created an average percentage for gastrocnemius muscle length that may be used clinically to identify the tendon for open/endoscopic lengthening and also to make simple and accurate localisation of gastrocnemius muscle-tendon junction for surgical access. This decreases the length of the surgical incision and may reduce the risk of iatrogenic injuries.

Keywords: Cerebral Palsy, Gastrocnemius Muscle, Gastrocnemius Lengthening, Muscle-tendon junction, Gastrocnemius, Tendon.