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Niedzwecki C, Barbuto A, Mitchell K, Wirt S, Seymour M, Thomas S, Schwabe A. Comparison of outcomes following surgical intervention and inpatient rehabilitation stays in children with cerebral palsy. PM R 2024; 16:449-461. [PMID: 37801614 DOI: 10.1002/pmrj.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/28/2023] [Accepted: 09/01/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Literature is limited on functional outcomes in children with cerebral palsy (CP) following surgical procedures and a subsequent inpatient rehabilitation unit (IRU) stay. OBJECTIVE To compare functional outcomes and length of stay (LOS) in children with CP following a surgical procedure and IRU stay based on the surgical procedure performed, pattern of involvement, etiology, and Gross Motor Function Classification System (GMFCS) level. DESIGN Retrospective cohort study. SETTING Tertiary care pediatrics. PARTICIPANTS Pediatric patients with CP who underwent one of three surgical procedures followed by an IRU stay. INTERVENTIONS Selective dorsal rhizotomy (SDR), single-event multilevel orthopedic surgery (SEMLS), or intrathecal baclofen (ITB) pump implantation and subsequent IRU stay. MAIN OUTCOME MEASURES IRU LOS, Functional Independence Measure for Children (WeeFIM) total score, sub-scores, and efficiency. RESULTS Children undergoing SDR had a longer LOS (p ≤ .015). Children with spastic diplegia, GMFCS level II, and prematurity-based CP had higher WeeFIM efficiency scores (p ≤ .046, ≤.021, and .034 respectively). Greater changes in WeeFIM™ scores were associated with spastic diplegia, SDR, GMFCS level II, longer LOS, and higher admission scores (p ≤ .045). CONCLUSIONS Although statistically and functionally significant improvements in children with CP following surgical interventions and an IRU stay were seen, those with higher WeeFIM change scores tended to have spastic diplegia, to have undergone SDR, GMFCS level II, longer LOS, and higher admission scores.
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Affiliation(s)
- Christian Niedzwecki
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Amy Barbuto
- Department of Physical and Occupational Therapy, Texas Children's Hospital-The Woodlands, The Woodlands, Texas, USA
| | - Katy Mitchell
- Department of Physical Therapy, Texas Woman's University-Houston, Houston, Texas, USA
| | - Steven Wirt
- Department of Physical and Occupational Therapy, Texas Children's Hospital-Main Campus, Houston, Texas, USA
| | - Michelle Seymour
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Sruthi Thomas
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Aloysia Schwabe
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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Song AX, Saad A, Hutnik L, Chandra O, McGrath A, Chu A. A PRISMA-IPD systematic review and meta-analysis: does age and follow-up improve active range of motion of the wrist and forearm following pediatric upper extremity cerebral palsy surgery? Front Surg 2024; 11:1150797. [PMID: 38444901 PMCID: PMC10913191 DOI: 10.3389/fsurg.2024.1150797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
Purpose Surgical treatments such as tendon transfers and muscle lengthening play a significant role in cerebral palsy management,but timing of upper extremity cerebral palsy surgery remains controversial. This study systematically reviews the current literature and investigates the correlation between age at surgery and follow-up time with surgical outcomes in pediatric upper extremity cerebral palsy patients. Methods A comprehensive search of PubMed, Cochrane, Web of Science, and CINAHL databases was performed from inception to July 2020 and articles were screened using PRISMA guidelines to include full-text, English papers. Data analysis was performed using itemized data points for age at surgery, follow-up length, and surgery outcomes, reported as changes in active forearm and wrist motion. A 3D linear model was performed, to analyze the relationship between age, follow-up length, and surgery outcomes. Results A total of 3,855 papers were identified using the search terms and a total of 8 studies with itemized patient data (n=126) were included in the study. The studies overall possessed moderate bias according to the ROBINS-I scale. Regression analysis showed that age is a significant predictor of change (|t| > 2) in active forearm supination (Estimate = -2.3465, Std. Error = 1.0938, t-value= -2.145) and wrist flexion (Estimate = -2.8474, Std. Error = 1.0771, t-value = -2.643) post-intervention, with older individuals showing lesser improvements. The duration of follow-up is a significant predictor of improvement in forearm supination (Estimate = 0.3664, Std. Error = 0.1797, t-value = 2.039) and wrist extension (Estimate = 0.7747, Std. Error = 0.2750, t-value = 2.817). In contrast, forearm pronation (Estimate = -0.23756, Std. Error = 0.09648, t-value = -2.462) and wrist flexion (Estimate = -0.4243, Std. Error=0.1859, t-value = -2.282) have a significant negative association with follow-up time. Conclusion These results suggest that there is significant correlation between the age and follow up after surgery with range of motion gains. Most notably, increased age at surgery had a significant negative correlation with select active range of motion postoperative outcomes. Future research should focus on identifying other factors that could affect results of surgical treatment in upper extremity.
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Affiliation(s)
- Amy X. Song
- Department of Orthopedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Anthony Saad
- Department of Orthopedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Lauren Hutnik
- Department of Orthopedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Onrina Chandra
- Department of Statistics, Rutgers University, New Brunswick, NJ, United States
| | - Aleksandra McGrath
- Department of Clinical Science, Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Alice Chu
- Department of Orthopedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
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Maaoui R, Karoui S, Hfaidh M, Mouhli N, Ezzine Z, Ksibi I, Rahali H, Barakizou H, Hamdi K. Cerebral palsy of the child in rehabilitation environment: epidemiologic and clinical profile and therapeutic modalities. LA TUNISIE MEDICALE 2023; 101:642-647. [PMID: 38445427 PMCID: PMC11217962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/17/2023] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of permanent disorders of the development of movement and posture causing activity limitation. AIM To evaluate the epidemiological, clinical, and radiological profile of children with CP and to study the therapeutic modalities in daily clinical practice. METHOD This was a retrospective, descriptive study, carried out in a physical medicine and rehabilitation department, including all the patients referred with the diagnosis of cerebral palsy between January 2000 and December 2016. We used pre-established records to collect data. The missing data were collected from the files of the pediatric department. To classify cerebral palsy, we used a motor impairment classification, topographic classification according to the affected limb and the GMFCS - ER. RESULTS Fifty patients were included with a gender ratio of 1.23. The mean age of patients was 7.8 years old. The risk factors for CP were mainly represented by perinatal asphyxia (55%) and prematurity (37%). The spastic form was predominant (74%). Quadriplegia was the most severe clinical form (61%). Neuro-orthopedic deformations were found in 78% of cases. Half of the children had GMFCS score between 1 and 2. Brain MRI lesions were dominated by anoxic-ischemic sequelae (34%). Physical therapy was prescribed for all patients. The most prescribed devices were the dynamic ankle foot orthosis (60%). Baclofen was prescribed in 5% of cases and botulinum toxin injection was performed in 30% of children. CONCLUSION The cerebral palsy defines the clinical and functional disorders caused by non-progressive developmental damage to the brain of the infant which requires a multidisciplinary management.
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Affiliation(s)
- Rim Maaoui
- Physical medicine and rehabilitation department, Military hospital of Tunis
| | - Souad Karoui
- Physical medicine and rehabilitation department, Military hospital of Tunis
| | - Meriem Hfaidh
- Physical medicine and rehabilitation department, Military hospital of Tunis
| | - Najla Mouhli
- Physical medicine and rehabilitation department, Military hospital of Tunis
| | - Zied Ezzine
- Physical medicine and rehabilitation department, Military hospital of Tunis
| | - Imene Ksibi
- Physical medicine and rehabilitation department, Military hospital of Tunis
| | - Hajer Rahali
- Physical medicine and rehabilitation department, Military hospital of Tunis
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R L, Gupta V, Mishra N, Gupta S, Behera P. Changes in the Status of Spastic Diplegic Children in Terms of Gross Motor Function Classification System and Functional Mobility Scale Following Surgical Intervention: A Single Centre Experience. Cureus 2023; 15:e35105. [PMID: 36945285 PMCID: PMC10024936 DOI: 10.7759/cureus.35105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Most centers in low- to mid-income countries (LMICs) lack facilities for a comprehensive instrumented gait analysis (IGA) which is often considered the preferred method for assessment of the functional results of surgery in children with spastic diplegia. We aimed to study if there were any changes in the Gross Motor Function Classification System (GMFCS) levels and Functional Mobility Scale (FMS) scores after surgery and whether they can be used as an indirect indicator of change in the functional status of a child. Methods This prospective study was conducted at the Pediatric Orthopedic unit of a teaching hospital on spastic diplegic children requiring surgical intervention. GMFCS levels and FMS scores were recorded before the surgery and at each follow-up visit, with the latest record being two years post-surgery. The change in the scores was indicated as an improvement, deterioration, or no change from the baseline and compared to the score of the preceding visit. In addition, it was examined whether the age at surgery had any effect on the temporal change in the scores. Results A total of 25 children were included for analysis after excluding those who failed to fulfill the predefined inclusion and exclusion criteria. Both the GMFCS levels and FMS scores improved from the third month to one-year post-surgery, after which a few patients had a worsening of their scores at the two years follow-up visit. The age at which surgery was performed had no significant effect on the pattern of change in the scores. Most children sought consultations with the physical therapy department only when they visited the surgical team for follow-up. Conclusion This study shows that surgical interventions do improve the functional outcomes in children with spastic CP when assessed using FMS scores while maintaining an undeteriorated GMFCS level in most children. While a peak improvement can be expected one year after surgery in most patients, possible of worsening from baseline scores do exist, and the parents must be informed of the same. Any decision for surgery must involve the parents, and the usefulness of postoperative physical therapy must be impressed upon them before the surgery and during each follow-up visit too.
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Affiliation(s)
- Laxmish R
- Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Vikas Gupta
- Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Nitu Mishra
- Obstetrics and Gynecology, Gandhi Medical College, Bhopal, IND
- Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Shubhangi Gupta
- Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Prateek Behera
- Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
- Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Bezuidenhout L, Church C, Henley J, Salazar-Torres JJ, Lennon N, Shields T, Miller F, Shrader MW. The effect of medial only versus medial and lateral hamstring lengthening on transverse gait parameters in cerebral palsy. J Pediatr Orthop B 2023; 32:80-86. [PMID: 36445368 DOI: 10.1097/bpb.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Benefits of hamstring lengthening surgery on the sagittal plane in children with cerebral palsy have been previously demonstrated, but there is limited information on its effects on the transverse plane. This study compared the effects of medial hamstring lengthening (MHL) with those of medial and lateral hamstring lengthening (MLHL) procedures in the transverse plane. Children with gross motor function classification system (GMFCS) levels I-III who had MHL or MLHL were included. Baseline, short- (1-2 years), and long-term (3+ years) postoperative three-dimensional gait analysis outcomes were compared using analysis of variance. Children were excluded if they had concurrent osteotomies or tendon transfers. One hundred fifty children (235 limbs) were included, with 110 limbs in the MHL group (age 8.5 ± 4.1 years, GMFCS I-27%, II-52%, and III-21%) and 125 limbs in the MLHL group (age 10.0 ± 4.0 years, GMFCS I-23%, II-41%, and III-37%). Time between surgery and short- and long-term follow-up gait analysis was 1.5 ± 0.6 years and 6.6 ± 2.9 years, respectively. Transmalleolar axis became more external after MHL at both short and long terms ( P < 0.05), whereas there were only significant differences at long term in MLHL ( P < 0.05). Although hamstring lengthening has a positive impact on stance phase knee extension in children with cerebral palsy, intact lateral hamstrings after MHL likely contribute to increased tibial external rotation after surgery. Significant increases in external rotation at the knee in the long term are likely related to a trend present with growth in children with cerebral palsy rather than a direct result of surgical intervention.
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Affiliation(s)
- Louis Bezuidenhout
- Department of Orthopedics, University of Alberta, Edmonton, Alberta, Canada
| | - Chris Church
- Department of Orthopedics, Nemours Children's Health, Wilmington, Delaware, USA
| | - John Henley
- Department of Orthopedics, Nemours Children's Health, Wilmington, Delaware, USA
| | | | - Nancy Lennon
- Department of Orthopedics, Nemours Children's Health, Wilmington, Delaware, USA
| | - Thomas Shields
- Department of Orthopedics, Nemours Children's Health, Wilmington, Delaware, USA
| | - Freeman Miller
- Department of Orthopedics, Nemours Children's Health, Wilmington, Delaware, USA
| | - M Wade Shrader
- Department of Orthopedics, Nemours Children's Health, Wilmington, Delaware, USA
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Visscher R, Hasler N, Freslier M, Singh NB, Taylor WR, Brunner R, Rutz E. Long-term follow-up after multilevel surgery in cerebral palsy. Arch Orthop Trauma Surg 2022; 142:2131-2138. [PMID: 33620528 DOI: 10.1007/s00402-021-03797-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/12/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Single-event multilevel surgery (SEMLS) is frequently used to correct pathological gait patterns in children with bilateral spastic cerebral palsy (BSCP) in a single session surgery. However, in-depth long-term evaluation reports of gait outcomes are limited. Therefore, we investigated if SEMLS is able to correct lower extremity joint and pelvic angles during gait towards typically developing gait patterns (TDC) in children with BSCP, and if so, if this effect is durable over a 10-year period. MATERIALS AND METHODS In total 13 children with BSCP GMFCS level II at time of index-surgery between the ages of 7.7-18.2 years at the time of SEMLS were retrospectively recruited. Three-dimensional gait data were captured preoperatively, as well as at short-, mid-, and long-term post-operatively, and used to analyze: movement analysis profile (MAP), gait profile score (GPS), and lower extremity joint and pelvic angles over the course of a gait cycle using statistical parametric mapping. RESULTS In agreement with previous studies, MAP and GPS improved towards TDCs after surgery, as did knee extension during the stance phase (ɳ2 = 0.67; p < 0.001), while knee flexion in the swing phase (ɳ2 = 0.67; p < 0.001) and pelvic tilt over the complete gait cycle (ɳ2 = 0.36; p < 0.001) deteriorated; no differences were observed between follow-ups. However, further surgical interventions were required in 8 out of 13 of the participants to maintain improvements 10 years post-surgery. CONCLUSIONS While the overall gait pattern improved, our results showed specific aspects of the gait cycle actually deteriorated post-SEMLS and that a majority of the participants needed additional surgery, supporting previous statements for the use of multilevel surgery rather than SEMLS. The results highlight that the field should not only focus on the overall gait scores when evaluating treatment outcomes but should offer additional long-term follow-up of lower extremity function.
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Affiliation(s)
- Rosa Visscher
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, HCP H16.1, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
| | - Nadine Hasler
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, HCP H16.1, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Marie Freslier
- Laboratory of Movement Analysis, University Children's Hospital Basel (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland
| | - Navrag B Singh
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, HCP H16.1, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - William R Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, HCP H16.1, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Reinald Brunner
- Laboratory of Movement Analysis, University Children's Hospital Basel (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland
- Faculty of Medicine, The University of Basel, 4001, Basel, Switzerland
| | - Erich Rutz
- Laboratory of Movement Analysis, University Children's Hospital Basel (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland
- Murdoch Children's Research Insitute, Pediatric Orthopedic Department, The University of Melbourne, The Royal Children's Hospital RCH, 50 Flemington Road, Parkville, Melbourne, 3052, Australia
- Faculty of Medicine, The University of Basel, 4001, Basel, Switzerland
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de Freitas Guardini KM, Kawamura CM, Lopes JAF, Fujino MH, Blumetti FC, de Morais Filho MC. Factors related to better outcomes after single-event multilevel surgery (SEMLS) in patients with cerebral palsy. Gait Posture 2021; 86:260-265. [PMID: 33813186 DOI: 10.1016/j.gaitpost.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/08/2021] [Accepted: 03/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Good outcomes have been described after single-event multilevel surgery (SEMLS) in cerebral palsy (CP); however, there is limited evidence regarding factors influencing them. RESEARCH QUESTION What were the factors related to kinematic outcomes after SEMLS in the present study? METHODS Two hundred and fifty-eight patients with spastic diplegic CP, GMFCS I-III, who underwent SEMLS and had done pre and post-operative gait analyses were included in the SEMLS Group (SEMLS-G). A second search was performed in the same database looking for patients to compose the Control Group (CG), and 88 subjects, with at least two gait analyses and with no surgical intervention between tests, were identified. Demographic data, GDI and GPS (Gait Profile Score) were analyzed in both groups, and the results compared. A second evaluation was performed in the SEMLS-G in order to identify the influence of age, gender, follow-up time, pre-operative GDI, GMFCS and gait velocity on results. RESULTS The GDI (51.3-58.4) and GPS (2.5°) improvement occurred only in SEMLS-G (p < 0.001). On sagittal plane, there was an improvement at the knee and ankle levels in SEMLS-G, whereas the pelvic alignment improved in the CG. In SEMLS-G, patients with improvement on GDI > 10 points had lower pre-operative GDI (46.15) than other groups (p < 0.001). In addition, patients with reduction on GDI after intervention had lower pre-operative gait velocity than subjects with improvement >10 points (p = 0. 01). The increase on GDI after SEMLS was greater in patients GMFCS I and II than GMFCS III (p = 0.003). There was a negative effect of GMFCS III on GDI improvement after intervention (p = 0.014). SIGNIFICANCE Lower pre-operative GDI, higher baseline gait velocity and GMFCS levels I and II were related to better outcomes after SEMLS in the present study. On the other hand, patients GMFCS III were more susceptible to deteriorate after SEMLS.
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Affiliation(s)
| | | | | | - Marcelo H Fujino
- Gait Laboratory and Cerebral Palsy Clinic, AACD, São Paulo, Brazil
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Chin EM, Gwynn HE, Robinson S, Hoon AH. Principles of Medical and Surgical Treatment of Cerebral Palsy. Neurol Clin 2020; 38:397-416. [PMID: 32279717 DOI: 10.1016/j.ncl.2020.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cerebral palsy is the most common cause of childhood motor disability, affecting 2 to 3/1000 children worldwide. Clinical abnormalities in tone, posture, and movement are the result of brain dysgenesis or injury early in life, and impairment varies in type, distribution, and in severity. The underlying brain disorder may also lead to other associated neurologic and systemic impairments. Variability in functional impairments, which can change during development, necessitates an individualized treatment plan. Treatment options are primarily symptomatic and directed toward optimizing independence, function, and/or ease of care-while limiting side effects. New promising disease-preventing and modifying treatments are emerging.
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Affiliation(s)
- Eric M Chin
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA.
| | - Hilary E Gwynn
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA
| | - Shenandoah Robinson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Phipps Building Rm 101, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Alexander H Hoon
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA
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Kuchen DB, Eichelberger P, Baur H, Rutz E. Long-term follow-up after patellar tendon shortening for flexed knee gait in bilateral spastic cerebral palsy. Gait Posture 2020; 81:85-90. [PMID: 32693350 DOI: 10.1016/j.gaitpost.2020.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/08/2020] [Accepted: 07/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Flexed knee gait is a common gait dysfunction in individuals with bilateral spastic cerebral palsy (BSCP) and is often addressed with single event multilevel surgery (SEMLS). SEMLS has been shown to have positive short-term effects especially on sagittal knee joint kinematics with less knee flexion during stance phase. However, mid- and long-term observations are rare, and results are reported in discrete parameters or summary statistics where temporal aspects are not considered. RESEARCH QUESTION Does the improved knee joint kinematics after patellar tendon shortening (PTS) as part of SEMLS persist in the long-term in individuals with BSCP? METHODS Data of instrumented gait analysis of twelve participants (females/males: 5/7, mean age: 15.3 ± 3.4 years) with BSCP treated with PTS as part of SEMLS were retrospectively analyzed. Participants had had follow-up gait analysis 1, 5 and 7 years or more after surgery. Three-dimensional lower extremity kinematics of walking at a self-selected speed were collected using a 12-camera motion capture system and 4 embedded force plates. One-dimensional statistical parametric mapping (SPM) was used for data analysis, permitting time point comparisons of continuous data. RESULTS Time point comparison revealed no significant differences in the sagittal plane for knee joint kinematics (p > 0.05) over the tree measurement time points. Hip and ankle joint kinematics as well as normalised walking speed remained stable over the observation period. SIGNIFICANCE This is the first study investigating lower extremity kinematics in patients with BSCP and flexed knee gait after SEMLS with SPM. Results demonstrate that positive effects on sagittal knee joint kinematics of PTS as part of SEMLS persist up to 9 years after surgery and progressivity does not reoccur. Thus, if clinical examination indicates an operation in individuals with BSCP, improved kinematics through SEMLS persist into adulthood. With the relatively new statistical procedure SPM gait can be displayed and analysed in established joint angle curves making them easier to understand (e.g. physiotherapists, movement scientists, physicians).
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Affiliation(s)
| | | | - Heiner Baur
- Bern University of Applied Sciences, Health Department, Bern, Switzerland
| | - Erich Rutz
- University Children's Hospital, UKBB, Basel Switzerland and the University of Basel, Switzerland; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Melbourne, Australia; The Royal Children's Hospital, Orthopaedic Department, Parkville, Melbourne, Australia
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10
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Functional outcomes after selective dorsal rhizotomy followed by minimally invasive tendon lengthening procedures in children with spastic cerebral palsy. J Pediatr Orthop B 2020; 29:1-8. [PMID: 31305364 DOI: 10.1097/bpb.0000000000000642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many surgical options have been proposed to improve the ambulatory status of children with spastic cerebral palsy (CP), but none have focused on addressing both spasticity and lower extremity tendon contractures. The purpose of this study is to evaluate the results of selective dorsal rhizotomy (SDR) followed by minimally invasive tendon lengthening allowing immediate return to ambulation. Two hundred fifty-five spastic CP patients (who received SDR procedure at an average age of 6.9±2.6 years and tendon lengthening procedure at an average age of 7.2±2.5 years) were retrospectively reviewed. Patients were grouped by the gross motor function classification system (GMFCS) 1-3 and 4-5. Kaplan-Meier analysis and Cox proportional hazard model using a requirement for additional tendon lengthening as an end point were conducted. Tendon lengthening followed SDR at an average of 4.3±10.7 months. On an average of 4.9±1.2 years after tendon lengthening, GMFCS was improved in 28 and maintained in 213 patients, respectively. There was no difference of variables and joint angles between the two GMFCS groups. A repeat tendon lengthening was required in 19 patients. The Kaplan-Meier analysis showed 81% success rate. Cox proportional hazard model identified age at tendon lengthening [hazards ratio (HR), 0.53; 95% confidence interval (CI), 0.37-0.76] and duration between SDR and tendon lengthening of more than 6 months (HR, 2.96; 95% CI, 1.05-8.33) associated with need for a repeat tendon lengthening procedure. Our novel approach of SDR/tendon lengthening results in improved joint angles as well as stable or improved GMFCS. Longer follow-up is necessary to determine if this approach could prolong ambulatory ability and reduced need for more invasive orthopedic surgeries.
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Amirmudin NA, Lavelle G, Theologis T, Thompson N, Ryan JM. Multilevel Surgery for Children With Cerebral Palsy: A Meta-analysis. Pediatrics 2019; 143:peds.2018-3390. [PMID: 30918016 DOI: 10.1542/peds.2018-3390] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Multilevel surgery (MLS) is standard care for reducing musculoskeletal disorders among children with spastic cerebral palsy (CP). OBJECTIVE To summarize the literature examining effects of MLS and satisfaction with MLS for children with CP. DATA SOURCES Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched. STUDY SELECTION Studies in which authors reported effects of or satisfaction with MLS in children with CP were selected. DATA EXTRACTION Two authors screened and extracted data on gross motor function, gait speed, gait (eg, Gait Profile Score), range of motion, strength, spasticity, participation, quality of life, satisfaction, and adverse events. RESULTS Seventy-four studies (3551 participants) were identified. One was a randomized controlled trial (RCT) (n = 19); the remainder were cohort studies. Pooled analysis of cohort studies revealed that MLS did not have a long-term effect on gross motor function (standardized mean difference [SMD]: 0.38; 95% confidence interval [CI]: -0.25 to 1.01) or gait speed (SMD: 0.12; 95% CI: -0.01 to 0.25) but did improve gait (SMD: -0.80; 95% CI: -0.95 to -0.65). The RCT also revealed no effect of MLS on gross motor function but improvements in the Gait Profile Score at 1 year. Participation and quality of life were reported in only 5 studies, and adverse events were adequately reported in 17 studies. LIMITATIONS Data were largely from cohort studies. CONCLUSIONS Findings reveal that gait, but not gross motor function, improves after MLS. RCTs and improved reporting of studies of MLS are required.
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Affiliation(s)
- Noor Amirah Amirmudin
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grace Lavelle
- Department of Clinical Sciences, Brunel University London, London, United Kingdom; and
| | - Tim Theologis
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Nicky Thompson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jennifer M Ryan
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; .,Department of Clinical Sciences, Brunel University London, London, United Kingdom; and
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Undercorrection of planovalgus deformity after calcaneal lengthening in patients with cerebral palsy. J Pediatr Orthop B 2018; 27:206-213. [PMID: 28151778 DOI: 10.1097/bpb.0000000000000436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Calcaneal lengthening (CL) is one of the treatment options for planovalgus deformity in patients with cerebral palsy (CP). However, its indication still needs to be clarified according to the functional status of CP. The aim of this study was to investigate the radiographic outcome after CL in patients with CP and to evaluate the risk factors causing undercorrection of planovalgus deformities. We included consecutive patients with CP who underwent CL for planovalgus deformity, were followed for more than 2 years, and had preoperative and postoperative weight-bearing anteroposterior (AP) and lateral foot radiographs. Six radiographic indices were used to assess the radiographic outcome. The patient age, sex, and Gross Motor Function Classification System (GMFCS) level were evaluated as possible risk factors, and we controlled for the interaction of potentially confounding variables using multivariate analysis. A total of 44 (77 feet) patients were included in this study. The mean age of the patients at the time of surgery was 10.5±4.0 years and the mean follow-up was 5.1±2.2 years. Patients with GMFCS III/IV achieved less correction than those with GMFCS I/II in the AP talus-first metatarsal angle (P=0.001), lateral talocalcaneal angle (P=0.028), and the lateral talus-first metatarsal angle (P<0.001). The rate of undercorrection in the GMFCS III/IV group was 1.6 times higher than that in the GMFCS I/II group in the AP talus-first metatarsal angle (odds ratios: 1.6; 95% confidence interval: 1.2-2.0; P<0.001) and 1.6 times higher in the lateral talus-first metatarsal angle (odds ratios: 1.6; 95% confidence interval: 1.3-1.9; P<0.001). In GMFCS I/II patients with CP, we found CL to be an effective procedure for the correction of planovalgus foot deformities. However, in GMFCS III/IV patients with planovalgus deformities, CL appears to be insufficient on the basis of the high rate of undercorrection in these patients. For patients with GMFCS level III/IV, additional or alternative procedures should be considered to correct the deformity and maintain the correction achieved. LEVEL OF EVIDENCE Level III, therapeutic study.
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Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study. PLoS One 2018; 13:e0192573. [PMID: 29408925 PMCID: PMC5800595 DOI: 10.1371/journal.pone.0192573] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 01/25/2018] [Indexed: 11/19/2022] Open
Abstract
To improve gait in children with spastic paresis due to cerebral palsy or hereditary spastic paresis, the semitendinosus muscle is frequently lengthened amongst other medial hamstring muscles by orthopaedic surgery. Side effects on gait due to weakening of the hamstring muscles and overcorrections have been reported. How these side effects relate to semitendinosus morphology is unknown. This study assessed the effects of bilateral medial hamstring lengthening as part of single-event multilevel surgery (SEMLS) on (1) knee joint mechanics (2) semitendinosus muscle morphology and (3) gait kinematics. All variables were assessed for the right side only. Six children with spastic paresis selected for surgery to counteract limited knee range of motion were measured before and about a year after surgery. After surgery, in most subjects popliteal angle decreased and knee moment-angle curves were shifted towards a more extended knee joint, semitendinosus muscle belly length was approximately 30% decreased, while at all assessed knee angles tendon length was increased by about 80%. In the majority of children muscle volume of the semitendinosus muscle decreased substantially suggesting a reduction of physiological cross-sectional area. Gait kinematics showed more knee extension during stance (mean change ± standard deviation: 34±13°), but also increased pelvic anterior tilt (mean change ± standard deviation: 23±5°). In most subjects, surgical lengthening of semitendinosus tendon contributed to more extended knee joint angle during static measurements as well as during gait, whereas extensibility of semitendinosus muscle belly was decreased. Post-surgical treatment to maintain muscle belly length and physiological cross-sectional area may improve treatment outcome of medial hamstring lengthening.
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Delafontaine A, Presedo A, Mohamed D, Lopes D, Wood C, Alberti C. Equimolar mixture of nitroux oxyde and oxygen during post-operative physiotherapy in patients with cerebral palsy: A randomized, double-blind, placebo-controlled study. Eur J Pain 2017; 21:1657-1667. [PMID: 28726270 DOI: 10.1002/ejp.1071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The administration of an equimolar mixture of nitrous oxide and oxygen (N2O) is recommended during painful procedures. However, the evaluation of its use during physiotherapy after surgery has not been reported, although pain may hamper physiotherapy efficiency. This study investigated whether the use of N2O improves the efficacy of post-operative physiotherapy after multilevel surgery in patients with cerebral palsy. METHOD It was a randomized 1:1, double-blind, placebo-controlled study. All patients had post-operative physiotherapy starting the day after surgery. Patients received either N2O or placebo gas during the rehabilitation sessions. All patients had post-operative pain management protocol, including pain medication as needed for acute pain. The primary objective was to reach angles of knee flexion of 110° combined with hip extension of 10°, with the patient lying prone, within six or less physiotherapy sessions. Secondary evaluation criteria were the number of sessions required to reach the targeted angles, the session-related pain intensity and the analgesics consumption for managing post-operative pain. RESULTS Sixty-four patients were enrolled. Targeted angles were achieved more often in the N2O group (23 of 32, 72%, vs. Placebo: 13/ of 32, 41%; p = 0.01). CONCLUSION The administration of N2O during post-operative physiotherapy can help to achieve more quickly an improved range of motion, and, although not significant in our study, to alleviate the need for pain medication. Further studies evaluating the administration of N2O in various settings are warranted. SIGNIFICANCE During this randomized placebo-controlled double-blind study, children receiving nitrous oxide and oxygen (N2O) achieved more often the targeted range of motion during physiotherapy sessions after multilevel surgery. Compared to placebo, nitrous oxide and oxygen (N2O) enabled a better management of acute pain related to physiotherapy procedures.
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Affiliation(s)
- A Delafontaine
- AP-HP, Hôpital Robert Debré, Service de Chirurgie Orthopédique, Paris, France
| | - A Presedo
- AP-HP, Hôpital Robert Debré, Service de Chirurgie Orthopédique, Paris, France
| | - D Mohamed
- AP-HP, Hôpital Robert-Debré, URC- UEC, Paris, France
| | - D Lopes
- AP-HP, Hôpital Robert Debré, Service de Chirurgie Orthopédique, Paris, France
| | - C Wood
- Centre de la Douleur Chronique, CHU Dupuytren, Limoges, France
| | - C Alberti
- AP-HP, Hôpital Robert-Debré, URC- UEC, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, UMR-S1123, ECEVE, Paris, France.,INSERM, U1123 and CIC-1426, ECEVE, Paris, France
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Schranz C, Kruse A, Kraus T, Steinwender G, Svehlik M. Does unilateral single-event multilevel surgery improve gait in children with spastic hemiplegia? A retrospective analysis of a long-term follow-up. Gait Posture 2017; 52:135-139. [PMID: 27907872 DOI: 10.1016/j.gaitpost.2016.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/30/2016] [Accepted: 11/07/2016] [Indexed: 02/02/2023]
Abstract
Single event multilevel surgery (SEMLS) has become a standard intervention for children with cerebral palsy (CP). SEMLS proved to improve the gait in bilateral spastic cerebral palsy and those improvements can be maintained in the long term. However there is no evidence on the long-term outcome of unilateral SEMLS in children with unilateral spastic cerebral palsy. The gait analyses and clinical data of 14 children (9 male/5 female, mean age 12.1) with unilateral CP (6 children Gross Motor Function Classification System Scale level I and 8 children level II) were retrospectively reviewed at four time-points: preoperatively, 1year, 3-5 years and approximately 10 years after unilateral SEMLS. The Gait Profile Score (GPS) of the affected leg was used as a main and the number of fine tuning procedures as well as complications rate (Clavien-Dindo classification) as secondary outcome measures. The gait improved postoperatively and the GPS of the affected leg significantly declined by 3.73° which is well above the minimal clinical important difference of 1.6°. No deterioration of GPS occurred throughout the follow-up period. Therefore the postoperative improvement was maintained long-term. However, additional fine-tuning procedures had to be performed during the follow-up in 5 children and three complications occurred (one level II and two level III). The results indicate that children with unilateral cerebral palsy benefit from unilateral SEMLS and maintain gait improvements long-term.
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Affiliation(s)
- Christian Schranz
- Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
| | - Annika Kruse
- Institute of Sport Science, University of Graz, Mozartgasse 14/I, A-8010 Graz, Austria
| | - Tanja Kraus
- Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria
| | - Gerhardt Steinwender
- Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria
| | - Martin Svehlik
- Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria
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The effectiveness of posterior knee capsulotomies and knee extension osteotomies in crouched gait in children with cerebral palsy. J Pediatr Orthop B 2016; 25:543-50. [PMID: 27392300 DOI: 10.1097/bpb.0000000000000370] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Crouched gait is common in children with cerebral palsy (CP), and there are various treatment options. This study evaluated the effectiveness of single-event multilevel surgery including posterior knee capsulotomy or distal femoral extension osteotomy to correct knee flexion contracture in children with CP. Gait analyses were carried out to evaluate gait preoperatively and postoperatively. Significant improvements were found in physical examination and kinematic measures, which showed that children with CP and crouched gait who develop knee flexion contractures can be treated effectively using single-event multilevel surgery including a posterior knee capsulotomy or distal femoral extension osteotomy.
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Lamberts RP, Burger M, du Toit J, Langerak NG. A Systematic Review of the Effects of Single-Event Multilevel Surgery on Gait Parameters in Children with Spastic Cerebral Palsy. PLoS One 2016; 11:e0164686. [PMID: 27755599 PMCID: PMC5068714 DOI: 10.1371/journal.pone.0164686] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/29/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Three-dimensional gait analysis (3DGA) is commonly used to assess the effect of orthopedic single-event multilevel surgery (SEMLS) in children with spastic cerebral palsy (CP). PURPOSE The purpose of this systematic review is to provide an overview of different orthopedic SEMLS interventions and their effects on 3DGA parameters in children with spastic CP. METHODS A comprehensive literature search within six databases revealed 648 records, from which 89 articles were selected for the full-text review and 24 articles (50 studies) included for systematic review. The Oxford Centre for Evidence-Based Medicine Scale and the Methodological Index for Non-Randomized Studies (MINORS) were used to appraise and determine the quality of the studies. RESULTS Except for one level II study, all studies were graded as level III according to the Oxford Centre for Evidence-Based Medicine Scale. The MINORS score for comparative studies (n = 6) was on average 15.7/24, while non-comparative studies (n = 18) scored on average 9.8/16. Nineteen kinematic and temporal-distance gait parameters were selected, and a majority of studies reported improvements after SEMLS interventions. The largest improvements were seen in knee range of motion, knee flexion at initial contact and minimal knee flexion in stance phase, ankle dorsiflexion at initial contact, maximum dorsiflexion in stance and in swing phase, hip rotation and foot progression angles. However, changes in 3DGA parameters varied based on the focus of the SEMLS intervention. DISCUSSION The current article provides a novel overview of a variety of SEMLS interventions within different SEMLS focus areas and the post-operative changes in 3DGA parameters. This overview will assist clinicians and researchers as a potential theoretical framework to further improve SEMLS techniques within different SEMLS focus groups. In addition, it can also be used as a tool to enhance communication with parents, although the results of the studies can't be generalised and a holistic approach is needed when considering SEMLS in a child with spastic CP.
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Affiliation(s)
- Robert P. Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Newlands, South Africa
| | - Marlette Burger
- Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Jacques du Toit
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Nelleke G. Langerak
- Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Abstract
BACKGROUND AND PURPOSE Instrumented 3-D gait analyses (GA) in children with cerebral palsy (CP) have shown improved gait function 1 year postoperatively. Using GA, we assessed the outcome after 5 years and evaluated parental satisfaction with the surgery and the need for additional surgery. PATIENTS AND METHODS 34 ambulatory children with spastic diplegia had preoperative GA. Based on this GA, the children underwent 195 orthopedic procedures on their lower limbs at a mean age of 11.6 (6-19) years. On average, 5.7 (1-11) procedures per child were performed. Outcome measures were evaluation of gait quality using the gait profile score (GPS) and selected kinematic parameters, functional level using the functional mobility scale (FMS), and the degree of parental satisfaction. RESULTS The mean GPS improved from 20.7° (95% CI: 19-23) preoperatively to 15.4° (95% CI: 14-17) 5 years postoperatively. There was no significant change in GPS between 1 and 5 years. The individual kinematic parameters at the ankle, knee, and hip improved statistically significantly, as did gait function (FMS). The mean parental satisfaction, on a scale from 0 to 10, was 7.7 (2-10) points. There was a need for additional surgical procedures in 14 children; this was more frequent in those who had the index operation at an early age. INTERPRETATION The main finding was that orthopedic surgery based on preoperative GA gave marked improvements in gait function and quality, which were stable over a 5-year period. Nevertheless, additional orthopedic procedures were necessary in almost half of the children and further follow-up with GA for more than 1 year postoperatively is recommended in children with risk factors for such surgery.
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Affiliation(s)
| | | | - Ingrid Skaaret
- Oslo Movement Laboratory, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Rutz E, Thomas S, Slongo T, Brunner R. [Osteotomy of the distal femur. Surgical technique using the LCP Pediatric Condylar Plate 90°]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2015; 27:221-36. [PMID: 26085070 DOI: 10.1007/s00064-015-0401-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/13/2014] [Accepted: 01/05/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Correction of all kind of deformities at the distal part of the femur (supracondylar). INDICATIONS Flexion, extension osteotomies, and varus or valgus, and external or internal rotation osteotomies, and shortening osteotomies of the distal femur or combined surgical procedures (e.g., extension and de-rotation osteotomy). CONTRAINDICATIONS Osteotomy through unknown bony process. SURGICAL TECHNIQUE LCP system provides angular stable fixation. POSTOPERATIVE MANAGEMENT Without concomitant surgical procedures of soft tissue (e.g., patellar tendon shortening), early functional rehabilitation is possible with immediate weight bearing (35 kg for small fragment plates and 70 kg for large fragment plates). RESULTS The surgical procedure is safe and is associated with few complications. Overall complication rate in this series of patients was 3%.
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Affiliation(s)
- E Rutz
- Neuroorthopädie, Universitäts-Kinderspital beider Basel (UKBB), Spitalstrasse 33, Postfach, 4031, Basel, Schweiz,
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Sossai R, Vavken P, Brunner R, Camathias C, Graham HK, Rutz E. Patellar tendon shortening for flexed knee gait in spastic diplegia. Gait Posture 2015; 41:658-65. [PMID: 25701014 DOI: 10.1016/j.gaitpost.2015.01.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 01/14/2015] [Accepted: 01/18/2015] [Indexed: 02/02/2023]
Abstract
UNLABELLED We evaluated the outcome of three different approaches to the management of flexed knee gait patients with spastic diplegia. The three surgical procedures were patellar tendon shortening (PTS), PTS combined with rotational osteotomies of the femur and/or tibia, and PTS combined with supracondylar extension osteotomy (SEO) of the distal femur. The primary outcome measure was gait kinematics. The knee gait variable score (GVS) and the gait profile score (GPS) were derived from gait kinematics. 24 patients (16 male and 8 female), mean age 16.1 years (SD 5.8 years), who had surgery between 2002 and 2008, were followed for a mean of 22 months. Knee extension during gait improved by a mean of 20° throughout the gait cycle, with an improvement in the knee GVS of 14° (p<0.001). The overall gait pattern improved with a mean decrease in GPS of 4.6°. Correction of patella alta was demonstrated by an improvement in the Koshino index from 1.34 pre-operatively to 1.10 post-operatively (p<0.001). Knee and gait kinematics, physical examination measures and Koshino Index improved in all three surgical groups, suggesting that a tailored approach to the correction of flexed knee gait in spastic diplegia is both feasible and appropriate. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Roberto Sossai
- Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland.
| | - Patrick Vavken
- Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland; Orthopaedic Department, University Hospital Basle, Switzerland; Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
| | - Reinald Brunner
- Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland
| | - Carlo Camathias
- Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland
| | - H Kerr Graham
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia
| | - Erich Rutz
- Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
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Quality of life and satisfaction after multilevel surgery in cerebral palsy: Confronting the experience of children and their parents. Ann Phys Rehabil Med 2014; 57:640-52. [DOI: 10.1016/j.rehab.2014.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 11/19/2022]
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Rutz E, Döderlein L, Svehlik M, Vavken P, Gaston MS. Critical considerations regarding 'the state of the evidence' for interventions in children with cerebral palsy. Dev Med Child Neurol 2014; 56:397-8. [PMID: 24628596 DOI: 10.1111/dmcn.12413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Erich Rutz
- University Children's Hospital Basle, Basle, Switzerland
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Alejandro De La Maza U. Aportes de la cirugía funcional en enfermedades discapacitantes: cirugía multinivel en parálisis cerebral. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70045-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Law S. Risk factors contributing to crouch gait in children with spastic cerebral palsy. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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