(A) Preoperative clinical presentation of a 13-year-old female with spastic diplegia and crouching gait, GMFCS II. (B) and (C) right and left extension lag of 17° and 11°, respectively. (D) Preoperative Koshino index left 1.5 and right 1.36. (E) and (F) Clinical picture 6 months after bilateral patellar tendon plication, bilateral iliopsoas tendinous release, left rectus femoris intramuscular lengthening and bilateral double column osteotomy. G. and H. Extension lag 5° right and 0° left knee. (I) and (J) Koshino index right knee 1 and left knee 0.9.