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Wang Z, Lu J, Ge H, Li Z, Zhang M, Pan F, Wang R, Jin H, Yang G, Shen Z, Du G, Zhan H. Morphology and transverse alignment of the patella have no effect on knee gait characteristics in healthy Chinese adults over the age of 40 years. Front Bioeng Biotechnol 2024; 12:1319602. [PMID: 38562671 PMCID: PMC10982314 DOI: 10.3389/fbioe.2024.1319602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Background: The influence of patella morphology and horizontal alignment on knee joint kinematics and kinetics remains uncertain. This study aimed to assess patella morphology and transverse alignment in relation to knee kinetics and kinematics in individuals without knee conditions. A secondary objective was to investigate the impact of femur and tibia alignment and shape on knee gait within this population. Patients and methods: We conducted a prospective collection of data, including full-leg anteroposterior and skyline X-ray views and three-dimensional gait data, from a cohort comprising 54 healthy individuals aged 40 years and older. Our study involved correlation and logistic regression analyses to examine the influence of patella, femur, and tibia morphology and alignment on knee gait. Results: The patellar tilt angle or the patella index did not show any significant relationships with different aspects of gait in the knee joint, such as velocity, angle, or moment (p > 0.05, respectively). Using multivariate logistic regression analysis, we found that the tibiofemoral angle and the Q angle both had a significant effect on the adduction angle (OR = 1.330, 95%CI 1.033-1.711, p = 0.027; OR = 0.475, 95%CI 0.285-0.792, p = 0.04; respectively). The primary variable influencing the knee adduction moment was the tibiofemoral angle (OR = 1.526, 95% CI 1.125-2.069, p = 0.007). Conclusion: In healthy Chinese individuals aged over 40, patella morphology and transverse alignment do not impact knee gait. However, the femoral-tibial angle has a big impact on the knee adduction moment.
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Affiliation(s)
- Zhengming Wang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jiehang Lu
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Haiya Ge
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Zhengyan Li
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Min Zhang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Fuwei Pan
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
- Department of Massage, Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Rui Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hengkai Jin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Guangyue Yang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhibi Shen
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Guoqing Du
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongsheng Zhan
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Gómez-Pérez C, Vidal Samsó J, Puig Diví A, Medina Casanovas J, Font-Llagunes JM, Martori JC. Relationship between spatiotemporal parameters and clinical outcomes in children with bilateral spastic cerebral palsy: Clinical interpretation proposal. J Orthop Sci 2023; 28:1136-1142. [PMID: 36216726 DOI: 10.1016/j.jos.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Understanding the links between gait disorders, impairments, and activity limitations is essential for correctly interpreting the instrumented gait analysis. We aimed to evaluate the relationships between spatiotemporal parameters and clinical outcomes in children with bilateral spastic cerebral palsy, and find out whether spatiotemporal parameters provide clinical information regarding gait pattern and walking. METHODS Data from 19 children with bilateral spastic cerebral palsy (nine males, ten females, 9.6 ± 2.8 years old) were collected retrospectively. All children underwent an instrumented gait analysis and a standardized clinical assessment. Seven spatiotemporal parameters were calculated: non-dimensional cadence, stride length, step width, gait speed, first double support, single support, and time of toe off. Clinical outcomes included measures of two different components of the International Classification of Functioning, Disability and Health - Children and Youth version: body functions and structures (spasticity, contractures and range of motion, and deformities), and activities and participation (gross motor function, and walking capacity). Pearson correlation, ANOVA, Student's t, Mann-Whitney U, and Kruskal-Wallis tests were used to analyze relationships. Spatiotemporal parameters related to clinical outcomes of body functions and structures were interpreted as outcome measures of gait pattern, while those related to clinical outcomes of activities and participation were interpreted as outcome measures of walking. RESULTS Non-dimensional cadence, stride length, and gait speed showed relationships (p < 0.05) with hip flexors spasticity and hindfoot deformity, ankle plantar flexors spasticity, and hindfoot deformity, respectively. All spatiotemporal parameters except non-dimensional cadence showed correlation (p < 0.05) with gross motor function and walking capacity. CONCLUSIONS Spatiotemporal parameters provide clinical information regarding both gait pattern and walking.
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Affiliation(s)
- Cristina Gómez-Pérez
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M(3)O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.
| | - Joan Vidal Samsó
- Institut Guttmann, Hospital de Neurorehabilitació, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Albert Puig Diví
- Blanquerna School of Health Sciences - Ramon Llull University, Barcelona, Spain
| | - Josep Medina Casanovas
- Institut Guttmann, Hospital de Neurorehabilitació, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Joan Carles Martori
- Data Analysis and Modeling Research Group, Department of Economics and Business, Faculty of Business and Communication Studies, University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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Min JJ, Kwon SS, Sung KH, Lee KM, Lee H, Chung CY, Park MS. What happens to the patella height in patients with cerebral palsy as they age. J Pediatr Orthop B 2022; 31:188-193. [PMID: 34561382 DOI: 10.1097/bpb.0000000000000917] [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: 11/26/2022]
Abstract
We aimed to investigate the progression of patella alta (PA) in patients with cerebral palsy (CP) using the Koshino-Sugimoto (KS) index and assess associated risk factors. Participants in our retrospective study met the following inclusion criteria: patients with CP who visited our institute from May 2003 to December 2019, were ≤18 years of age, were followed up for >2 years and had at least two lateral knee radiographs. KS indices of both knee radiographs were measured for each patient. A linear mixed model was implemented. Our participants included 222 CP patients. KS index values were measured via 652 knee radiographs. Reference values of the KS index for those between 4 and 18 years of age were determined according to Gross Motor Function Classification System (GMFCS) levels. In all GMFCS levels, the KS index decreased with patients' ages (P < 0.0001). In groups where the KS index increased, GMFCS levels IV (P = 0.0045) and V (P = 0.0040) were statistically significant. Change in the KS index values indicates that PA improves as patients age within all GMFCS levels. However, in patients with GMFCS levels of IV and V, progressive PA is expected.
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Affiliation(s)
- Jae Jung Min
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, Gyeonggi, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
| | - Hansang Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital
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Abstract
BACKGROUND Gait dysfunction associated with patella alta (PA) in subjects with cerebral palsy (CP) has been presumed but not objectively established clinically or through biomechanical modeling. It is hypothesized that PA is associated with increasing level of motor impairment, increasing age, obesity, and worse stance phase knee kinematics and kinetics in children with CP. METHODS Retrospective case series of 297 subjects with CP studied in our Motion Analysis Center. Data analyzed included patient demographics (age, body mass index, CP classification), patella height (Koshino-Sugimoto Index), and knee kinematics and kinetics. RESULTS PA was present in 180 of 297 subjects (61%), in 68 of the 146 (47%) with unilateral CP, and 112 of 151 subjects (74%) with bilateral CP. For unilateral CP, the prevalence of PA was not significantly different between Gross Motor Function Classification System (GMFCS) I and II (P=0.357). For bilateral CP, the prevalence of PA in GMFCS III was significantly greater than in GMFCS I and II (P=0.02). Regression analysis showed a significant trend between increasing age and PA in unilateral and bilateral groups (P<0.001 and 0.001, respectively). The prevalence of PA was not significantly different across body mass index categories for either unilateral or bilateral groups. There were only 2 of 10 significant correlations between PA and gait parameters for subjects with unilateral CP functioning at the GMFCS I and II levels. There were 8 of 12 significant correlations between PA and gait parameters for subjects with bilateral CP functioning at the GMFCS I, II, and III levels. CONCLUSIONS PA is common in ambulatory children with CP across topographic types and motor functional levels. PA is well tolerated with respect to gait dysfunction in unilateral CP, but may contribute to crouch gait in bilateral CP. Gait dysfunction cannot be inferred from the radiographic assessment of patellar height, and radiographic evidence of PA by itself does not justify surgical correction with patellar tendon advancement or shortening. LEVEL OF EVIDENCE Level III-prognostic, retrospective series.
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Tageldeen Mohamed M, Elsobky M, Hegazy M, Elbarbary HM, Abdelmohsen MM, Elsherbini M, Barakat AS, Diab NM. Evaluation of infrapatellar tendon plication in spastic cerebral palsy with crouch gait pattern: a pilot study. SICOT J 2020; 6:40. [PMID: 33030425 PMCID: PMC7543689 DOI: 10.1051/sicotj/2020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/22/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE In order to substantially improve crouch pattern in cerebral palsy, the existent patella alta needs to be addressed. This pilot study evaluates the effectiveness of a previously described infrapatellar tendon plication for the treatment of patella alta in crouch gait pattern in skeletally immature spastic cerebral palsy patients. METHODS In 10 skeletally immature patients (20 knees) with spastic diplegia and crouch gait, the previously described technique by Joseph et al. for infrapatellar tendon plication was evaluated within the setting of single event multilevel surgery (SEMLS). Outcome measures included knee extension lag, Koshino's radiological index for patella alta, and the occurrence of complications. Patients were followed-up for a minimum of 12 months. RESULTS The extensor lag improved and was statistically significant in all cases of the study with no incidence of tibial apophyseal injury at the latest follow-up. Radiographic Koshino index normalized and was maintained all through the follow-up period except in one patient (5%) who was overcorrected. Two patients (4 knees, 20%) showed postoperative knee stiffness due to casting which resolved with physiotherapy within six weeks. One knee (5%) developed a superficial infection which also resolved uneventfully with repeated dressings. CONCLUSION The described infra-patellar plication technique in skeletally immature spastic diplegics appears effective, safe, and reproducible.
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Affiliation(s)
- Mohamed Tageldeen Mohamed
- Orthopedics and Traumatology Department, Cairo University, Al-Saray Street, Manial, 11562 Cairo, Egypt
| | - Mohamed Elsobky
- Orthopedics and Traumatology Department, Cairo University, Al-Saray Street, Manial, 11562 Cairo, Egypt
| | - Mohamed Hegazy
- Orthopedics and Traumatology Department, Cairo University, Al-Saray Street, Manial, 11562 Cairo, Egypt
| | - Hassan M Elbarbary
- Orthopedics and Traumatology Department, Cairo University, Al-Saray Street, Manial, 11562 Cairo, Egypt
| | - Mohamed Mostafa Abdelmohsen
- Department of Orthopedic Surgery, National Institute of Neuromotor System, Corniche Al Nile Street, Imbaba, Giza, Egypt
| | - Mostafa Elsherbini
- Department of Orthopedic Surgery, National Institute of Neuromotor System, Corniche Al Nile Street, Imbaba, Giza, Egypt
| | - Ahmed Samir Barakat
- Orthopedics and Traumatology Department, Cairo University, Al-Saray Street, Manial, 11562 Cairo, Egypt
| | - Nader M Diab
- Orthopedics and Traumatology Department, Cairo University, Al-Saray Street, Manial, 11562 Cairo, Egypt
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Schroeder KM, Heydemann JA, Beauvais DH. Musculoskeletal Imaging in Cerebral Palsy. Phys Med Rehabil Clin N Am 2019; 31:39-56. [PMID: 31760993 DOI: 10.1016/j.pmr.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scoliosis, hip dysplasia, and other lower extremity deformities are common musculoskeletal pathology found in patients with cerebral palsy. Imaging studies allow for an improved identification of patients with these issues, help to understand the pathology, and aid in planning treatment strategies. Most of these deformities are visualized using plain radiographic techniques. Occasionally, as in the case of preoperative planning, advanced imaging, such as computerized topography and MRI, can be used for additional information. This article provides insight into the various imaging techniques for these musculoskeletal issues and aids in better care for patients with cerebral palsy.
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Affiliation(s)
- Katherine M Schroeder
- Division of Pediatric Orthopaedic Surgery, Texas Children's Hospital, 6701 Fannin Street, Suite 660, Houston, TX 77030, USA
| | - John A Heydemann
- Division of Pediatric Orthopaedic Surgery, Texas Children's Hospital, 6701 Fannin Street, Suite 660, Houston, TX 77030, USA
| | - Dorothy H Beauvais
- Division of Pediatric Orthopaedic Surgery, Texas Children's Hospital, 6701 Fannin Street, Suite 660, Houston, TX 77030, USA.
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