scholarly journals Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy

2019 ◽  
Vol 8 (9) ◽  
pp. 1354 ◽  
Author(s):  
Hoon Park ◽  
Byoung Kyu Park ◽  
Kun-Bo Park ◽  
Sharkawy Wagih Abdel-Baki ◽  
Isaac Rhee ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Pelvic Tilt ◽  
Flexion Contracture ◽  
Knee Flexion Contracture ◽  
Shortening Osteotomy ◽  
Femoral Shortening ◽  
Crouch Gait ◽  
Anterior Pelvic Tilt ◽  
The Mean

Although there have been advancements of surgical techniques to correct gait abnormalities seen in patients with cerebral palsy, the crouch gait remains one of the most difficult problems to treat. The purpose of this retrospective study was to examine our results of distal femoral shortening osteotomy (DFSO) and patellar tendon advancement (PTA), performed in patients with crouch gait associated with severe knee flexion contracture. A total of 33 patients with a mean fixed knee contracture of 38° were included in the study. The mean age at the time of surgery was 12.2 years and the mean follow-up was 26.9 months. The measurements of clinical, radiological, and gait parameters were performed before and after surgery. The mean degrees of knee flexion contracture, Koshino index of patella height, and Gait Deviation Index were found to be significantly improved at the time of final follow-up. The maximum knee extension during the stance phase improved by an average of 25°, and the range of knee motion during gait increased postoperatively. On the other hand, the mean anterior pelvic tilt increased by 9.9°. Also, the maximum knee flexion during the swing phase decreased and the timing of peak knee flexion was observed to be delayed. We conclude that combined procedure of DFSO and PTA is an effective and safe surgical method for treating severe knee flexion contracture and crouch gait. However, the surgeons should be aware of the development of increased anterior pelvic tilt and stiff knee gait after the index operation.

scholarly journals Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up

2012 ◽  
Vol 36 (9) ◽  
pp. 1835-1839 ◽  
Author(s):  
Sebastien Lustig ◽  
Corey J. Scholes ◽  
Tim J. Stegeman ◽  
Sam Oussedik ◽  
Myles R. J. Coolican ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Flexion Contracture ◽  
Knee Flexion Contracture ◽  
Total Knee ◽  
One Year

scholarly journals The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Evelina Pantzar-Castilla ◽  
Brian Po-Jung Chen ◽  
Freeman Miller ◽  
Jacques Riad
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Knee Flexion ◽  
Flexion Contracture ◽  
Short Term ◽  
Knee Flexion Contracture ◽  
Group 2 ◽  
Group 1

Abstract Background Indications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP). Methods Inclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11°; group 2: greater than or equal to 11°), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively. Results Sixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months. Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively. Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001. There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D. Conclusions Relative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.

Reliability of Heel-Height Measurement for Documenting Knee Extension Deficits

2002 ◽  
Vol 30 (4) ◽  
pp. 479-482 ◽  
Author(s):  
Theodore F. Schlegel ◽  
Martin Boublik ◽  
Richard J. Hawkins ◽  
J. Richard Steadman
Keyword(s):  
Range Of Motion ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Flexion Contracture ◽  
Height Measurement ◽  
Height Difference ◽  
Thigh Circumference ◽  
Flexion Contractures ◽  
Heel Height ◽  
Knee Flexion Contracture

Background Heel-height difference has been used to detect subtle knee flexion contractures, but the effects of thigh circumference differences and patient positioning during testing have not been evaluated. Hypothesis Differences in thigh circumference measurements and whether the patient's patellae are on or off the examination table during heel-height difference measurement will not affect the accuracy of detecting knee flexion contracture. Study Design Prospective cohort study. Methods Bilateral knee range of motion, prone heel-height difference with the patellae on and off the table, and thigh circumference at 5 and 15 cm proximal to the proximal pole of the patella were measured by one investigator on 50 consecutive patients who had undergone unilateral anterior cruciate ligament reconstruction. Results A high degree of correlation was demonstrated between the heel-height difference and the standard range of motion measurement. Differences in thigh girth and patellar position did not statistically affect the accuracy of the heel-height difference as an indicator of knee flexion contracture. Conclusion Heel-height difference is a valid method of documenting knee flexion contractures. Compared with traditional goniometer assessment, this test is a more meaningful and easier way for detecting subtle knee flexion contractures of less than 10°.

Using a Knee Arthrometer to Evaluate Tissue-specific Contributions to Knee Flexion Contracture in the Rat

10.3791/58084 ◽  
2018 ◽  
Author(s):  
T. Mark Campbell ◽  
Katherine Reilly ◽  
Louis Goudreau ◽  
Odette Laneuville ◽  
Hans Uhthoff ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Flexion Contracture ◽  
Tissue Specific ◽  
Knee Flexion Contracture

Standardization of lateral pelvic radiograph is necessary to predict spinopelvic mobility accurately

2020 ◽  
Vol 102-B (7_Supple_B) ◽  
pp. 41-46 ◽  
Author(s):  
Michael Ransone ◽  
Keith Fehring ◽  
Thomas Fehring
Keyword(s):  
Pelvic Tilt ◽  
Preoperative Planning ◽  
Sacral Slope ◽  
Sitting Posture ◽  
Sit To Stand ◽  
Pelvic Radiograph ◽  
Increased Risk ◽  
Anterior Pelvic Tilt ◽  
B 41 ◽  
The Mean

Aims Patients with abnormal spinopelvic mobility are at increased risk for instability. Measuring the change in sacral slope (ΔSS) can help determine spinopelvic mobility preoperatively. Sacral slope (SS) should decrease at least 10° to demonstrate adequate posterior pelvic tilt. There is potential for different ΔSS measurements in the same patient based on sitting posture. The purpose of this study was to determine the effect of sitting posture on the ΔSS in patients undergoing total hip arthroplasty (THA). Methods In total, 51 patients undergoing THA were reviewed to quantify the variability in preoperative spinopelvic mobility when measuring two different sitting positions using SS for planning. Results A total of 32 patients had standardized relaxed sitting radiographs, while 35 patients had standardized flexed sitting images. Of the 32 patients with relaxed sitting views, the mean ΔSS was 20.7° (SD 8.9°). No patients exhibited an increase in SS during relaxed sitting (i.e. anterior pelvic tilt or so-called reverse accommodation). Of the 35 patients with flexed sitting radiographs, the mean ΔSS was only 2.1° (SD 9.7°) with 16/35 (45.71%) showing anterior pelvic tilt, or so-called reverse accommodation, unexpectedly increasing the sitting SS compared to the standing SS. Overall, 18 patients had both relaxed sitting and flexed sitting radiographs. In patients with both types of sitting radiographs, the mean relaxed sit to stand ΔSS was 18.06° (SD 6.07°), while only a 3.00° (SD 10.53°) ΔSS was noted when flexed sitting. There was a mean ΔSS difference of 15.06° (SD 7.67°) noted in the same patient cohort depending on sitting posture (p < 0.001). Conclusion A 15° mean difference was noted depending on the sitting posture of the patient. Since decisions on component position can be made on preoperative lateral sit-stand radiographs, postural standardization is crucial. If using ΔSS for preoperative planning, the relaxed sitting radiograph is preferred. Cite this article: Bone Joint J 2020;102-B(7 Supple B):41–46.

scholarly journals Association of knee flexion contracture with radiographic disease worsening in persons with or at high risk for knee OA

2020 ◽  
Vol 28 ◽  
pp. S358-S359
Author(s):  
A.H. Chang ◽  
J. Lee ◽  
J. Song ◽  
J.S. Chmiel ◽  
K.C. Moisio ◽  
...  
Keyword(s):  
High Risk ◽  
Knee Flexion ◽  
Flexion Contracture ◽  
Knee Oa ◽  
Knee Flexion Contracture ◽  
Radiographic Disease
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