Assessment of the Hip and Knee Flexion Contractures in Cerebral Palsy Patients with Crouch Gait

PURPOSE: The aim of this study was to examine the relationship between gait analysis measures associated with crouch gait, functional health status and daily activity in ambulant cerebral palsy (CP). METHODS: Three-dimensional gait analysis was carried out on 35 ambulant participants with bilateral CP crouch gait (knee flexion at mid-stance (KFMS) ⩾ 190). KFMS, knee-flexion at initial contact, gait speed and step-lengths were extracted for analysis. Steps/day and sedentary time/day were assessed using an ActivPAL accelerometer. Functional health status was assessed using the five relevant domains of the Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire. Associations between variables were assessed with correlation coefficients and multivariable linear regression. RESULTS: There were no significant correlations between KFMS and PODCI domains ρ=-0.008–0.110) or daily activity ρ=-0.297–0.237) variables. In contrast, multivariable analysis found that step-length was independently associated with the Sports and Physical Function (p= 0.030), Transfers and Basic Mobility (p= 0.041) and Global Function (< 0.001) domains of the PODCI assessment. Gait speed was independently associated with mean steps/day (p< 0.001). CONCLUSIONS: Step length and gait speed are more strongly associated with functional health status and daily activity than knee flexion during stance in children and adolescents with CP crouch gait.

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Do Not Do this Case Report: Recurrence of Knee Flexion Contracture after Extension Osteotomy in Congenital Patellar Dislocation: The Importance of a Thorough Patient Evaluation

Journal of Orthopedic and Spine Trauma ◽

10.18502/jost.v5i2.3754 ◽

2020 ◽

Author(s):

Soroush Baghdadi ◽

Taghi Baghdadi

Keyword(s):

Cerebral Palsy ◽

Case Report ◽

Knee Flexion ◽

Patellar Dislocation ◽

Gait Pattern ◽

Flexion Contracture ◽

Tibial Rotation ◽

Patient Evaluation ◽

Second Surgery ◽

Crouch Gait

Background: Congenital patellar dislocation (CPD) is a rare disorder which presents with hypoplastic and irreducible patellae. It is accompanied by flexion contracture of the knee joint, genu valgum, and external tibial rotation. Case Report: A seven-year-old girl with CPD who was misdiagnosed as having cerebral palsy (CP) crouch gait and underwent distal femoral extension osteotomy (DFEO) without paying attention to the dislocated patellae, is presented. Recurrence ensued, and the patient was referred for further evaluation. After a second surgery to address the dislocated patellae, the flexion contracture and gait pattern improved significantly. Conclusion: The case underscores the importance of a systematic, thorough physical examination, without which uncommon diagnoses will be overlooked, exposing the patient to further morbidity and complications.

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Effectiveness of tendon-muscle plasty of the knee joint in patients having spastic cerebral palsy with flexion contractures of knee joints

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2020-24-4-272-277 ◽

2020 ◽

Vol 24 (4) ◽

pp. 272-277

Author(s):

Maria O. Volkova ◽

K. V. Zherdev ◽

O. B. Chelpachenko ◽

S. P. Yatsyk

Keyword(s):

Cerebral Palsy ◽

Knee Joint ◽

Knee Flexion ◽

Reference Group ◽

Standing Position ◽

Spastic Cerebral Palsy ◽

X Ray ◽

Radiological Criteria ◽

Flexion Contractures ◽

Before And After

Introduction. Cerebral palsy (CP) is the main cause of childhood neurological disability in the world. Due to the fact that the prevalence of knee contractures in children with cerebral palsy occupies the 3rd place in the structure of orthopedic pathology of the lower extremities, this topic is least covered in the scientific periodicals. Material and methods. Findings from 40 patients of the main group, aged 7-12 and having cerebral palsy (CP), were studied retrospectively. They had knee flexion contractures with patella alta. Findings of goniometry and of Gillette FAQ were analyzed before and after surgery. The Spearman coefficient was used for the correlation analysis of goniometry parameters and surgical intervention effectiveness before surgery. 35 patients having no bilateral CP damage and other diseases leading to lower limb deformities were included into the reference group. X-ray examination and goniometry assessment of a healthy limb were made in patient’s lying position on his back with passive extension; plus goniometry in a standing position with shin active extension. Results. The median of deformation angles before and after surgery was 20° and 5°, respectively (p <0.05). Correction volume was 80%. The median of scores by the Gillette increased from 2 to 3 (p <0.05) after surgery. Assessment of the correlation between preoperative goniometry values and treatment efficacy values showed a significant moderate feedback (p <0.05). Conclusion. The stronger the deformity before surgery, the less chance for developing the standing-up function. The best result can be achieved when deformity is 10-25°. Normal values of passive extension by goniometry in a healthy knee for children aged 7-12 in a lying position are 6 ° hyper-extension (genu recurvatum) (± 2 °) and 12 ° hyper-extension (±3°) of a knee joint by lateral X-ray. Normal active extension in children aged 7-12 in a standing position is 3° hyper-extension (±2°). Smaller values of the tibiofemoral angle by goniometry in a standing position and maximun values for passive extension by X-ray and goniometry assessment may serve as clinical and radiological criteria of knee flexion contracture.

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Effectiveness of Serial Stretch Casting for Resistant or Recurrent Knee Flexion Contractures Following Hamstring Lengthening in Children With Cerebral Palsy

Journal of Pediatric Orthopaedics ◽

10.1097/01.bpo.0000187990.71645.ae ◽

2006 ◽

Vol 26 (1) ◽

pp. 109-114 ◽

Cited By ~ 32

Author(s):

David E Westberry ◽

Jon R Davids ◽

Jeannine M Jacobs ◽

Linda I Pugh ◽

Stephanie L Tanner

Keyword(s):

Cerebral Palsy ◽

Knee Flexion ◽

Flexion Contractures ◽

Children With Cerebral Palsy

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THE EFFECTS OF TRANSLATORIC JOINT MOBILIZATION ON KNEE FLEXION CONTRACTURES IN AN ADOLESCENT WITH CEREBRAL PALSY: A CASE REPORT

Pediatric Physical Therapy ◽

10.1097/00001577-200601810-00047 ◽

2006 ◽

Vol 18 (1) ◽

pp. 95

Author(s):

Melodie Kondratek ◽

Sarah Francis

Keyword(s):

Cerebral Palsy ◽

Case Report ◽

Knee Flexion ◽

Joint Mobilization ◽

Flexion Contractures

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

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.200154 ◽

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

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