Distal femoral osteotomy and patellar tendon advancement for the treatment of crouch gait in patients with bilateral spastic cerebral palsy.

Autor: Nabian MH; Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran; Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France., Zadegan SA; Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA., Mallet C; Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France., Neder Y; Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France., Ilharreborde B; Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France., Simon AL; Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France., Presedo A; Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France. Electronic address: ana.presedo@aphp.fr.
Jazyk: angličtina
Zdroj: Gait & posture [Gait Posture] 2024 May; Vol. 110, pp. 53-58. Date of Electronic Publication: 2024 Mar 02.
DOI: 10.1016/j.gaitpost.2024.02.019
Abstrakt: Background: Crouch gait, or flexed knee gait, represents a common gait pattern in patients with spastic bilateral cerebral palsy (CP). Distal femoral extension and/or shortening osteotomy (DFEO/DFSO) and patellar tendon advancement (PTA) can be considered as viable options when knee flexion contractures are involved. Better outcomes have been reported after a combination of both, independently of the presence of knee extensor lag. In this study, we evaluated the clinical and kinematic outcomes of these procedures.
Patients and Methods: We reviewed a cohort of 52 limbs (28 patients) who were treated for crouch gait by DFEO/DFSO alone (group 1, n = 15) or DFEO/DFSO + PTA (group 2, n = 37) as a part of single event multilevel surgery (SEMLS). The mean age at surgery was 14 years, and the mean follow-up time was 18 months. The physical examination data and three-dimensional standardized gait analysis were collected and analyzed before the surgery and postoperatively.
Results: Overall knee range of motion improved in all limbs. The knee flexion decreased significantly in both groups at initial, mid, and terminal stance. Hip flexion significantly decreased in mid-stance for limbs in group 2. Both clinical and gait parameters were most improved in limbs who underwent DFEO/DFSO + PTA. Increased pelvic tilt was observed in both groups after surgery.
Conclusion: Although DFEO/DFSO alone was successful in correcting knee flexion contractures, PTA has helped to improve knee extensor lag and knee extension during gait.
Level of Evidence: Therapeutic level IV.
Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to disclose.
(Copyright © 2024. Published by Elsevier B.V.)
Databáze: MEDLINE
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