Evidence of knee extensor dysfunction during sit-to-stand following distal femoral extension osteotomy and patellar tendon advancement in young adults with cerebral palsy: A pilot study
| Autor: | Tom F. Novacheck, Sarah M Gutknecht, Jean L. Stout, Meghan E. Munger, Michael H. Schwartz, Elizabeth R. Boyer, Jennifer C. Laine, Lucas H Araujo de Oliveira |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Knee Joint medicine.medical_treatment Tendon Transfer 0206 medical engineering Biophysics Pilot Projects 02 engineering and technology Osteotomy Cerebral palsy Young Adult 03 medical and health sciences 0302 clinical medicine Patellar Ligament otorhinolaryngologic diseases medicine Humans Orthopedics and Sports Medicine Young adult Gait Retrospective Studies Knee extensors Sit to stand business.industry Cerebral Palsy Rehabilitation Patella medicine.disease 020601 biomedical engineering Patellar tendon Biomechanical Phenomena Surgery Physical therapy Female business 030217 neurology & neurosurgery |
| Zdroj: | Gait & Posture. 58:527-532 |
| ISSN: | 0966-6362 |
| DOI: | 10.1016/j.gaitpost.2017.09.018 |
| Popis: | A distal femoral extension osteotomy with patellar tendon advancement (DFEO+PTA) is a common treatment for individuals with cerebral palsy (CP) who walk in crouch. Musculoskeletal modeling suggests that the typical patella baja position post-DFEO+PTA may limit one's abilities to perform sit-to-stand (STS) tasks; however, STS function has not been assessed. Our purpose was to compare how well individuals who received a DFEO+PTA can perform a 5-times STS test (FTSST) eight or more years after surgery compared to their peers who did not receive a DFEO+PTA (non-DFEO+PTA group). Twenty-one participants completed the task (12 DFEO+PTA, 9 non-DFEO+PTA). Three-dimensional kinematics and kinetics were captured. Kinetics were non-dimensionalized to facilitate group comparisons. Non-DFEO+PTA participants performed the FTSST moderately faster than the DFEO+PTA group (median(IQR), 14.6(9.3) seconds vs. 20.3(10.1) seconds, non-parametric effect size ɣ=0.97, p=0.241). Peak negative knee power was larger for the non-DFEO+PTA group (Mean±SD, -0.063±0.025 vs. -0.048± 0.020, Cohen's d=0.66, p=0.165). A similar but weaker trend was observed for negative hip power (median(IQR) -0.120(0.066) vs. -0.105(0.044), ɣ=0.43, p=0.671). Both groups used their hips approximately twice as much as their knees to perform the task. The functional deficit among DFEO+PTA participants may be due to patella baja decreasing the knee extensor moment arm, which concurs with the modeling prediction. The group differences may also be due to the non-DFEO+PTA group being slightly higher functioning. Future research is warranted to determine if optimizing patella position during a DFEO+PTA may improve unaided STS function without compromising gait improvements. |
| Databáze: | OpenAIRE |
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