The effect of the Majestro-Frost procedure on internal hip rotation during gait in patients with cerebral palsy.

Autor: de Morais Filho MC; Pediatric Orthopedic Surgeon, Gait Laboratory and Cerebral Palsy Clinic, AACD, São Paulo, Brazil. Electronic address: mfmorais@terra.com.br., Blumetti FC; Pediatric Orthopedic Surgeon, Gait Laboratory and Cerebral Palsy Clinic, AACD, São Paulo, Brazil., Kawamura CM; Senior Physical Therapist, Gait Laboratory, AACD, São Paulo, Brazil., Ferreira CL Júnior; Pediatric Orthopedic Fellow, AACD, São Paulo, Brazil., Lopes JAF; Engineer, Gait Laboratory, AACD, São Paulo, Brazil., Fujino MH; Pediatric Orthopedic Surgeon, Gait Laboratory and Cerebral Palsy Clinic, AACD, São Paulo, Brazil., Neves DL; Pediatric Orthopedic Surgeon, Gait Laboratory and Cerebral Palsy Clinic, AACD, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Gait & posture [Gait Posture] 2018 Oct; Vol. 66, pp. 32-37. Date of Electronic Publication: 2018 Aug 18.
DOI: 10.1016/j.gaitpost.2018.08.014
Abstrakt: Background: Muscle imbalance is related to persistent internal hip rotation (IHR) after femoral derotation osteotomy (FDO) in cerebral palsy (CP). The aim of this study was to evaluate the effect of the Majestro-Frost soft tissue procedure (MFP), which potentially addresses muscle imbalance, on IHR in CP patients during walking.
Methods: A retrospective study of an existing database (medical records and gait laboratory data) was conducted and a search was performed using the following inclusion criteria: (1) diagnosis of spastic CP, (2) GMFCS levels I-III; (3) mean IHR during stance phase higher than 11° at baseline; (4) individuals who received single event multilevel orthopedic surgery in the lower limbs and had three-dimensional gait analyses (3DGA) before and after the intervention. Patients who underwent a FDO were excluded. Eighty-three individuals were considered for the study and they were divided into two groups: No MFP (45 patients who did not receive a MFP) and MFP (36 patients who underwent a MFP). A full clinical examination and 3DGA, with kinematics calculated according to a standard software procedure (Plugin Gait), were performed before and after the intervention, and the results were compared.
Results: The studied groups matched regarding demographic data and GMFCS distribution. The mean follow-up time was more than 20 months on both groups. The increase of clinical external hip rotation (EHR) on physical examination was observed only in the MFP group (from 26.4° to 33°, p = 0.002). During gait analysis, IHR decreased from 21.2° to 4.5° in the MFP group (p < 0.001) and from 16.9° to 7.9° in the No MFP group (p < 0.001). The reduction of IHR during gait was more significant in the MFP group (p = 0.001).
Significance: In the present study, patients who underwent a MFP showed more reduction of IHR during gait than those which did not undergo a MFP.
(Copyright © 2018 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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