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The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy
Örebro University, School of Medical Sciences. Department of Orthopedics.
Department of Orthopedic Surgery, Nemours/AIfred I. duPont Hospital for Children, Wilmington, Delaware, USA; Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan .
Department of Orthopedic Surgery, Nemours/AIfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
Department of Orthopedics, Örebro University Hospital, Örebro, Sweden; Department of Orthopedics, Institute of Clinical Science,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopedics, Skaraborg Hospital Skövde, Skövde, Sweden.
2021 (English)In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 22, no 1, article id 481Article in journal (Refereed) Published
Abstract [en]

Background: Indications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP).

Methods: Inclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11 degrees; group 2: greater than or equal to 11 degrees), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively.

Results: Sixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months. Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively. Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001. There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D.

Conclusions: Relative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.

Place, publisher, year, edition, pages
BioMed Central, 2021. Vol. 22, no 1, article id 481
Keywords [en]
Cerebral palsy, Knee flexion contracture, Gait deviation index, Gait analysis, Orthopedic surgery
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-92340DOI: 10.1186/s12891-021-04362-xISI: 000657715600005PubMedID: 34034736Scopus ID: 2-s2.0-85106857965OAI: oai:DiVA.org:oru-92340DiVA, id: diva2:1565571
Note

Funding Agency:

Örebro University 

Available from: 2021-06-14 Created: 2021-06-14 Last updated: 2024-01-17Bibliographically approved
In thesis
1. Knee flexion contracture and flexed knee gait in children with cerebral palsy
Open this publication in new window or tab >>Knee flexion contracture and flexed knee gait in children with cerebral palsy
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cerebral palsy (CP) is considered the most common cause of physical disability in childhood. Most children will walk, but gait often deteriorates with growth and development. Walking with excessive knee flexion is commonly described, one cause being knee flexion contracture (KFC), which can progress to the extent that it restricts the child’s walking ability. The aim of this thesis work was to validate two-dimensional markerless (2D ML) gait analysis in assessing knee flexion angles during gait in children with CP. Also including analyzing if and to what extent KFC impacted the result of orthopedic surgery and studying the prevalence of KFC and its association with common physical functional measures. Another aim was to explorethe feasibility of the 2D ML assessment. Children with CP, gross motor function classification scale (GMFCS) level I, II, III (Studies I, II and IV), IV and V (Study III) were included. 2D ML, using a single video camera with computer processing (I, IV), and 3-dimensional gait analysis (3D GA) (I, II) were used. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectivelyand compared between two surgically matched groups based on theseverity of preoperative KFC (II). KFC, functional mobility scale(FMS), standing and transfer ability were assessed and their associations explored (III). The 2D ML method was used, to explore its usefulness in analyzing children with CP in different regions in Sweden (IV). The 2D ML method was found to overestimate the knee kinematics by between +3.3 and +7.0 degrees. The within-method reliability for both 2D ML and 3D GA showed mostly good to excellent results (I). In Study II, both group 1 with no/mild KFC and group 2 with moderate KFC showed significant improvements for all variables studied, except KFC, gait speed and gross motor function assessment in group 1. The prevalence of KFC was 27%, and increased KFC was associated with higher age and GMFCS level (III). A strong association was found between KFC and decreased physical function with lower FMS level and decreased standing and transfer ability(III). In Study IV, assessment of gait speed, step length and knee kinematics could be performed in a practical and reliable way and common mild to severe gait deviations could be identified.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2021. p. 80
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 247
Keywords
Cerebral palsy, knee flexion contracture, 2- and 3-dimensional gait analysis, video assessment, gait, flexed knee gait, functional measures, orthopedic surgery
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-92270 (URN)9789175294018 (ISBN)
Public defence
2021-10-08, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2021-06-09 Created: 2021-06-09 Last updated: 2021-10-22Bibliographically approved

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Pantzar-Castilla, Evelina

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