Table 2.

Concomitant procedures

Procedure	No. limbs	Indications	Techniques
Hamstring lengthening	31	Excessive knee flexion terminal swing/stance Popliteal angle > 40° Failed non-operative intervention	Open or percutaneous hamstring lengthening Medial lengthening is typical, though lateral hamstrings may be lengthened if tight after medial lengthening
Adductor lengthening	13	Excessive hip adduction during gait Hip abduction range < 40° in extension	Open or percutaneous lengthening of adductor longus +/- gracilis
Femoral derotational osteotomy	13	Excessive femoral anteversion statically Excessive internal hip rotation during gait interfering with function	Distal femoral derotational osteotomy in younger patients without hip subluxation Proximal in cases of hip subluxation, patients near skeletal maturity or the desire to avoid postoperative casting
Tibial derotational osteotomy	8	Excessive internal or external tibial torsion interfering with function	Distal tibial derotational osteotomy
Calcaneal osteotomy	16	Valgus foot that cannot be braced effectively, causes lever arm dysfunction and/or is painful and interferes with shoe and brace wear	Medial calcaneal sliding osteotomy most common Lateral column lengthening considered in GMFCS I/II with significant talar uncovering
Tendo-Achilles lengthening/Gastrocnemius recession	6	Static plantarflexion contracture Excessive plantarflexion during gait	Gastrocnemius recession (PF contracture only w/knee extended) TAL if PF contracture knee flexed and extended
Hallux valgus correction	7	Hallux valgus, painful and/or interfering with shoe wear	Fusion of the first metatarsophalangeal joint Hallux valgus reconstruction with proximal or distal metatarsal osteotomy considered in GMFCS I/II
Hardware removal	4	Pain	Dependent on hardware and location
None	8	–	–

GMFCS, Gross Motor Functional Classification System; PF, plantarflexion; TAL, tendo-Achilles lengthening