Long-Term Outcomes of Distal Femoral Extension Osteotomy and Patellar Tendon Advancement in Individuals with Cerebral Palsy
| Autor: | Tom F. Novacheck, Michael H. Schwartz, Jean L. Stout, Sarah M Gutknecht, Meghan E. Munger, Elizabeth R. Boyer, Jennifer C. Laine, Lucas H Araujo de Oliveira |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Osteoarthritis Osteotomy Cerebral palsy 03 medical and health sciences Young Adult 0302 clinical medicine Interquartile range Patellar Ligament medicine Humans Orthopedics and Sports Medicine Range of Motion Articular Child Gait Gait Disorders Neurologic Retrospective Studies 030222 orthopedics business.industry Cerebral Palsy Knee flexion contracture Femur Head General Medicine medicine.disease Knee pain Gait analysis Physical therapy Quality of Life Surgery Female medicine.symptom Range of motion business 030217 neurology & neurosurgery |
| Zdroj: | The Journal of bone and joint surgery. American volume. 100(1) |
| ISSN: | 1535-1386 |
| Popis: | Background We examined long-term outcomes across the domains of the International Classification of Functioning, Disability and Health for 2 groups of participants with cerebral palsy who demonstrated crouch gait at clinical gait analysis. One group underwent a distal femoral extension osteotomy with patellar tendon advancement (DFEO + PTA). The other group received other treatments (non-DFEO + PTA). Methods Fifty-one participants returned for a long-term gait analysis, physical examination, energy consumption test, knee radiographs, and questionnaires (median, 13 years post-DFEO + PTA or post-baseline [range, 8 to 21 years]). A subset of participants in the DFEO + PTA group also had a short-term analysis (9 to 24 months postoperatively). Results Participants were reasonably well-matched at baseline, although the DFEO + PTA group demonstrated greater crouch: minimum knee flexion, a median of 37° (width of the interquartile range, 12°) compared with 27° (9°); and knee flexion contracture, a median of 15° (10°) compared with 10° (5°). The gait deviation index (GDI) and sagittal plane knee kinematics were most improved at short term for the DFEO + PTA participants, with a subsequent slight decline at long-term analysis. Fewer DFEO + PTA participants were in crouch at long term (37% compared with 65%). At the long-term assessment, group scores for function, mobility, participation, quality of life, and most pain questionnaires were similar. Knee pain and osteoarthritis ratings did not differ between the groups. Conclusions At long-term analysis, DFEO + PTA improves stance phase knee extension and knee flexion contracture compared with conventional treatment, but these benefits do not translate to improved activity, participation, or knee pain in early adulthood. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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