scholarly journals Anterior distal femoral hemiepiphysiodesis with and without patellar tendon shortening for fixed knee flexion contractures in children with cerebral palsy

2020 ◽  
Vol 14 (5) ◽  
pp. 415-420
Author(s):  
Susan A. Rethlefsen ◽  
Alison M. Hanson ◽  
Tishya A. L. Wren ◽  
Oussama Abousamra ◽  
Robert M. Kay
Keyword(s):  
Cerebral Palsy ◽  
Patellar Tendon ◽  
Knee Flexion ◽  
Analysis Data ◽  
Knee Extension ◽  
Skeletally Immature ◽  
Level Of Evidence ◽  
Flexion Contractures ◽  
Children With Cerebral Palsy ◽  
Patellar Tendon Shortening

Purpose Surgery is often required for fixed knee flexion contractures in patients with neuromuscular conditions. Anterior distal femoral hemiepiphysiodesis (ADFH) is an alternative to distal femoral extension osteotomy (DFEO) in skeletally immature patients. ADFH is typically not accompanied by patellar tendon shortening surgery (PTS). Our purpose was to compare ADFH alone versus ADFH with PTS for treatment of fixed knee flexion contractures and crouched gait in children with cerebral palsy (CP). Methods Retrospective review of pre- and postoperative gait analysis data for children with CP who underwent ADFH alone, or ADFH with PTS. Data were analysed using linear mixed models to control for covariates. Results In total, 25 participants (42 limbs) were included, 17 male and eight female, mean age at surgery 12.9 (sd 1.9) years. Both groups experienced significant improvement in popliteal angle, knee extension range of motion (ROM) and knee extension in stance phase. Greater improvement was seen for all variables in the ADFH/PTS group, mainly due to greater popliteal angle and knee flexion during gait preoperatively in that group (p ≤ 0.02) rather than the procedure performed (p ≥ 0.19). There was no difference between groups postoperatively. Rate of contracture resolution was 0.5° to 1.0° per month, faster in larger contractures (p = 0.02). Conclusions ADFH with and without PTS is effective in improving knee extension in skeletally immature patients with CP, correcting contractures at a rate of 0.5° to 1.0° per month. Combined ADFH and PTS surgery may be preferable in patients with larger contractures of up to 30° to 35°. Level of evidence III

scholarly journals Calf lengthening may improve knee recurvatum in specific children with spastic diplegic cerebral palsy

2020 ◽  
Vol 14 (4) ◽  
pp. 353-357
Author(s):  
Jeremy Bauer ◽  
K. Patrick Do ◽  
Jing Feng ◽  
Michael Aiona
Keyword(s):  
Cerebral Palsy ◽  
Knee Flexion ◽  
Stance Phase ◽  
Knee Extension ◽  
Level Of Evidence ◽  
Kinematic Data ◽  
Clinical Exam ◽  
Knee Position ◽  
Difficult Condition ◽  
Knee Hyperextension

Purpose Knee hyperextension in stance is a difficult condition to treat in children with spastic diplegic cerebral palsy (CP). In children with passive knee hyperextension, the presence of contracture or spasticity of the calf leads to knee hyperextension in stance phase. We hypothesize surgical treatment of the contracture of the calf will lead to less knee hyperextension. Methods We performed a retrospective review of children who were evaluated in our movement laboratory over 23 years with a diagnosis of CP Gross Motor Function Classification System I, II or III. We selected children who had passive knee hyperextension on exam and who underwent calf lengthening surgery. Children were divided into two groups: early recurvatum (ER) (n = 20) and late recurvatum (LR) (n = 14). Results There was no difference in the preoperative passive knee extension among the groups or the surgeries performed. For children who had passive knee hyperextension, calf lengthening improved static dorsiflexion with knee flexion on clinical exam by 9.3° in the ER group, 9.6° in the LR group as well as dorsiflexion with knee extension on clinical exam by 9.5° in the ER group and 6.4° in the LR group. The kinematic data showed that the ER group improved their knee hyperextension by 11° (p < 0.001), whereas the LR group did not significantly change their stance phase knee position. Conclusion Children with passive knee hyperextension who have a calf contracture and walk in knee hyperextension in the first half of stance phase may improve after calf lengthening. Level of Evidence: III

scholarly journals Spontaneous decrease in gastrocnemius spasticity after correction of knee flexion gait in children with cerebral palsy

2019 ◽  
Vol 28 (1) ◽  
pp. 230949901989025
Author(s):  
Winson Min-Teng Low ◽  
Sue-Mei Wang ◽  
Kuo-Kuang Yeh ◽  
Chia-Hsieh Chang
Keyword(s):  
Cerebral Palsy ◽  
Knee Flexion ◽  
Plantar Flexion ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Knee Flexion Contracture ◽  
Postoperative Changes ◽  
Early Results ◽  
Children With Cerebral Palsy ◽  
Underlying Mechanisms

Purpose: Synergistic neuro-excitability in the lower extremities may be related to gait disorders. This study aimed to report spontaneous changes after correcting knee flexion gait and discuss the underlying mechanisms. Methods: A prospective study of 23 children with cerebral palsy was conducted to assess postoperative changes in gross motor function, joint range of motion (ROM), and spasticity. Characteristics of children/limbs with spontaneous decrease in gastrocnemius spasticity were assessed. Results: In 10 patients (19 limbs) without gastrocnemius release, the Modified Ashworth scores in the gastrocnemius decreased in 6 limbs after 3 months and in 10 limbs after 6 months. Those limbs with spontaneous changes had worse preoperative knee flexion contracture than the limbs without spasticity changes (knee ROM limitation score 5.4 vs. 3.7, p = 0.026). Conclusions: Patients with knee flexion contracture recruited greater plantar flexion–knee extension couple to balance knee flexion gait, and synergistic neuro-excitability of the gastrocnemius was enhanced. Our early results suggest preservation of the gastrocnemius in treating knee flexion gait, especially for patients with knee flexion contracture.

Patellar tendon shortening improves knee extension in cerebral palsy

2012 ◽  
Vol 36 ◽  
pp. S4-S5
Author(s):  
R. Sossai ◽  
R. Brunner ◽  
M.S. Gaston ◽  
C. Camathias ◽  
O. Tirosh ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Patellar Tendon ◽  
Knee Extension ◽  
Patellar Tendon Shortening

Distal Femoral Extension Osteotomy and Patellar Tendon Advancement in Management of Fixed Knee Flexion Deformity and Crouch Gait in Cerebral Palsy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Mohamed Emara ◽  
Sherif Ahmed El-Ghazaly ◽  
Mahmoud Ali Mahran ◽  
Mahmoud Ahmed Alsehemy
Keyword(s):  
Cerebral Palsy ◽  
Patellar Tendon ◽  
Knee Flexion ◽  
Knee Extension ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Flexion Deformity ◽  
The Mean ◽  
Knee Flexion Deformity

Abstract Background Cerebral palsy (CP) is generally associated with musculoskeletal deformities that occur during body growth. Fixed knee flexion deformity (FKFD) results from long standing knee flexion that is due to progressive contracture of spastic hamstrings combined with a quadriceps weakness. Fixed knee flexion compromises the passive mechanisms of joint stabilization at mid and terminal stance in children with CP. The aim of this study is to highlight the results of distal femoral extension osteotomy and patellar tendon advancement (DFEO + PTA) for management of FKFD in crouching CP patients with spastic or mixed tone diplegic ambulatory cerebral palsy children. Patients and Methods A prospective study was conducted involving twenty CP patients with fixed knee flexion deformity (14 males and 6 females). The 20 cases with fixed knee flexion deformity were GMFCS level II (4 cases), and III (16 cases). All patients were clinically and radiologically assessed according to knee flexion angle, extension lag, koshino index and the Gross motor function measure pre- and post-operative. All patients underwent DFEO ± PTA. Eighteen limbs had DFEO on the RT side, and twenty on the LT side. Results The mean age of the patients was 11.18±3.23 (6-16) years. The period of follow up ranged from 12 to 24 months (The mean follow up was 16.20 ± 2.46). At last follow up, the median knee flexion angle improved from 25 to 0. The median extension lag improved from 17.5 to 0. The mean koshino index improved from 1.59 ± 0.32 to 1.05 ± 0.10. the GMFM improved from 52.86 ± 7.36 to 68.15 ± 5. 82. Conclusion The combined procedure (DFEO + PTA) is effective in increasing knee extension in the stance phase, reducing knee pain and improving knee extension strength.

scholarly journals Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

2021 ◽  
pp. 1-9
Author(s):  
Robert M. Kay ◽  
Kristan Pierz ◽  
James McCarthy ◽  
H. Kerr Graham ◽  
Henry Chambers ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Rectus Femoris ◽  
Delphi Consensus ◽  
Level Of Evidence ◽  
Modified Delphi ◽  
International Panel ◽  
Children With Cerebral Palsy ◽  
Stiff Knee ◽  
Paediatric Orthopaedic ◽  
Gmfcs Level

Purpose The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method. Methods The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached. Results Consensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade. Conclusion This study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP. Level of evidence V

Sign in / Sign up

Export Citation Format

Share Document