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Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy

Although there have been advancements of surgical techniques to correct gait abnormalities seen in patients with cerebral palsy, the crouch gait remains one of the most difficult problems to treat. The purpose of this retrospective study was to examine our results of distal femoral shortening osteot...

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Autores principales: Park, Hoon, Park, Byoung Kyu, Park, Kun-Bo, Abdel-Baki, Sharkawy Wagih, Rhee, Isaac, Kim, Chan Woo, Kim, Hyun Woo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780050/
https://www.ncbi.nlm.nih.gov/pubmed/31480593
http://dx.doi.org/10.3390/jcm8091354
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author Park, Hoon
Park, Byoung Kyu
Park, Kun-Bo
Abdel-Baki, Sharkawy Wagih
Rhee, Isaac
Kim, Chan Woo
Kim, Hyun Woo
author_facet Park, Hoon
Park, Byoung Kyu
Park, Kun-Bo
Abdel-Baki, Sharkawy Wagih
Rhee, Isaac
Kim, Chan Woo
Kim, Hyun Woo
author_sort Park, Hoon
collection PubMed
description Although there have been advancements of surgical techniques to correct gait abnormalities seen in patients with cerebral palsy, the crouch gait remains one of the most difficult problems to treat. The purpose of this retrospective study was to examine our results of distal femoral shortening osteotomy (DFSO) and patellar tendon advancement (PTA), performed in patients with crouch gait associated with severe knee flexion contracture. A total of 33 patients with a mean fixed knee contracture of 38° were included in the study. The mean age at the time of surgery was 12.2 years and the mean follow-up was 26.9 months. The measurements of clinical, radiological, and gait parameters were performed before and after surgery. The mean degrees of knee flexion contracture, Koshino index of patella height, and Gait Deviation Index were found to be significantly improved at the time of final follow-up. The maximum knee extension during the stance phase improved by an average of 25°, and the range of knee motion during gait increased postoperatively. On the other hand, the mean anterior pelvic tilt increased by 9.9°. Also, the maximum knee flexion during the swing phase decreased and the timing of peak knee flexion was observed to be delayed. We conclude that combined procedure of DFSO and PTA is an effective and safe surgical method for treating severe knee flexion contracture and crouch gait. However, the surgeons should be aware of the development of increased anterior pelvic tilt and stiff knee gait after the index operation.
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spelling pubmed-67800502019-10-30 Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy Park, Hoon Park, Byoung Kyu Park, Kun-Bo Abdel-Baki, Sharkawy Wagih Rhee, Isaac Kim, Chan Woo Kim, Hyun Woo J Clin Med Article Although there have been advancements of surgical techniques to correct gait abnormalities seen in patients with cerebral palsy, the crouch gait remains one of the most difficult problems to treat. The purpose of this retrospective study was to examine our results of distal femoral shortening osteotomy (DFSO) and patellar tendon advancement (PTA), performed in patients with crouch gait associated with severe knee flexion contracture. A total of 33 patients with a mean fixed knee contracture of 38° were included in the study. The mean age at the time of surgery was 12.2 years and the mean follow-up was 26.9 months. The measurements of clinical, radiological, and gait parameters were performed before and after surgery. The mean degrees of knee flexion contracture, Koshino index of patella height, and Gait Deviation Index were found to be significantly improved at the time of final follow-up. The maximum knee extension during the stance phase improved by an average of 25°, and the range of knee motion during gait increased postoperatively. On the other hand, the mean anterior pelvic tilt increased by 9.9°. Also, the maximum knee flexion during the swing phase decreased and the timing of peak knee flexion was observed to be delayed. We conclude that combined procedure of DFSO and PTA is an effective and safe surgical method for treating severe knee flexion contracture and crouch gait. However, the surgeons should be aware of the development of increased anterior pelvic tilt and stiff knee gait after the index operation. MDPI 2019-09-01 /pmc/articles/PMC6780050/ /pubmed/31480593 http://dx.doi.org/10.3390/jcm8091354 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Park, Hoon
Park, Byoung Kyu
Park, Kun-Bo
Abdel-Baki, Sharkawy Wagih
Rhee, Isaac
Kim, Chan Woo
Kim, Hyun Woo
Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy
title Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy
title_full Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy
title_fullStr Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy
title_full_unstemmed Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy
title_short Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy
title_sort distal femoral shortening osteotomy for severe knee flexion contracture and crouch gait in cerebral palsy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780050/
https://www.ncbi.nlm.nih.gov/pubmed/31480593
http://dx.doi.org/10.3390/jcm8091354
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