The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy
2021 (English)In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 22, no 1, article id 481
Article 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
2021-06-142021-06-142024-01-17Bibliographically approved
In thesis