Stage 2: Deformity Correction & Balancing

CP-MMA — Muscle Strength & Tone Adjustment

A specialized surgical intervention designed to correct musculoskeletal deformities and balance muscle power. CP-MMA is the essential second step in Professor Sun Chenyan's integrated approach to cerebral palsy and hemiplegia.

Bridging Neurosurgery and Orthopedics

While FSPR surgery effectively removes the "neurological handbrake" of spasticity, years of high muscle tone often leave patients with physical contractures and skeletal misalignments. CP-MMA (Cerebral Palsy Muscle Strength & Tone Adjustment) is the surgical bridge that translates nerve-level improvement into physical, functional alignment.

Key Components of CP-MMA

The surgery is highly individualized, often involving multiple procedures in a single session:

  • Tendon Lengthening: Safely extending shortened tendons (like the Achilles) to allow full joint extension.
  • Muscle Transfers: Moving a muscle's attachment point to change its function (e.g., turning a muscle that causes inward rotation into one that helps with outward rotation).
  • Myotomy & Tenotomy: Precise release of over-tight muscle fibers or tendons.
  • Skeletal Alignment: Addressing rotational deformities in the long bones or joints caused by chronic spastic pull.

The "Balance" Principle

Prof. Sun Chenyan's CP-MMA technique is grounded in the principle of dynamic balance. We don't just "loosen" tight muscles; we carefully calculate the ratio of strength between opposing muscle groups (agonists and antagonists) to ensure the limb moves smoothly and stays in a neutral, functional position during rest and activity.

Clinical Indication

CP-MMA is recommended for patients who have achieved spasticity reduction but still struggle with fixed joint positions, tip-toe walking (equinus), "scissoring" of the legs, or hand deformities that prevent grasping.

Surgical Outcomes

  • Flat-Foot Walking: Correction of equinus foot allows for a natural heel-to-toe gait.
  • Increased Stability: Better muscle balance leads to improved center of gravity and reduced fall risk.
  • Functional Reach: In upper limbs, CP-MMA helps straighten the wrist and open the palm for grasping objects.
  • Enhanced Rehab Efficiency: Corrected limbs respond significantly faster to physical therapy and robotic training.

CP-MMA Surgery — FAQs

When is CP-MMA surgery performed?
CP-MMA is typically Stage 2 of the Eber Protocol. It is performed after spasticity has been permanently reduced through FSPR (Stage 1). While FSPR targets the nerves, CP-MMA targets the muscles, tendons, and bones to correct residual deformities.
What specific issues does CP-MMA address?
It addresses 'fixed' deformities that spasticity reduction alone cannot fix: heel cord shortening (equinus foot), knee flexion contractures, hip adduction, and bone rotations. It balances the 'pull' of different muscle groups to ensure the limb is functionally aligned.
Is CP-MMA a major surgery?
It is a comprehensive orthopedic-style surgery but performed with the precision of functional neurosurgeons. Recovery involves 4-7 days of hospitalization and immediate initiation of the Stage 3 rehabilitation program.