Cerebral palsy is the most common neurological disorder in children, and hemiplegia occurs in about 30% of cases [1], [2]. Although the primary lesion is not progressive, the secondary consequences comprise tonic disorder (spasticity, dyskinesia) in the upper limb, associated with motor command deficit affecting movement (range of motion, dexterity and fluidity) and thus function, both for unimanual and bimanual performance [3], [4]. Iterative focal treatment of hypertonia by botulinum toxin injections aims to limit neuro-orthopedic deterioration and preserve function, and has been shown to be effective in achieving functional goals when combined with specific occupational therapy [5], [6]. However, soft tissue retraction and osteo-articular deformity are common, despite preventive measures such as muscle stretching, orthoses or casts, for which there is currently little evidence of effectiveness [6], [7]. Upper-extremity surgery can improve muscle balance and hand posture, by releasing or lengthening spastic muscles, transferring tendons, or stabilising joints. To date, there is little evidence of efficacy, whether on body structure [8], [9], [10], [11], [12], [13], or on activity and participation [14] as defined by the International Classification of Functioning, Disability and Health domains [15]. Studies often only show a pre/post effect, with very short follow-up. The most recent review [14] even concluded that the very low level of evidence prohibits recommendations for upper-extremity surgery to guide clinical practice and underlines the need for further research in this area.

The aims of the present study were to investigate the effects of individualised multisite neuro-orthopedic upper-limb surgery in children with unilateral cerebral palsy on unilateral functional capacity and bimanual performance, to explore the factors affecting the effects of surgery, and to investigate patient and family satisfaction several months after surgery.