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Krajewski KT, Miller S, Dimovski R, Rhodes J, De S. Retrograde Insertion Approach for Anterior Distal Femoral Hemiepiphysiodesis Procedure: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00042. [PMID: 39208151 DOI: 10.2106/jbjs.cc.24.00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
CASE A 13-year-old adolescent boy with spastic diplegic cerebral palsy (CP) presented with crouch gait and bilateral knee flexion contractures (KFCs). After failure of conservative treatments, the patient was referred to orthopaedics for surgical intervention. Anterior distal femoral hemiepiphysiodesis (ADFH), using a retrograde approach, and Strayer gastrocnemius recession were performed bilaterally. No complications were reported during surgery/follow-up. Full-active knee extension and improved gait were achieved. CONCLUSION KFC is prevalent in ambulatory patients with CP, reducing gait function. Retrograde ADFH is an effective surgical intervention to reduce KFC and improve gait, and offers simpler insertion/removal than the traditional antegrade technique.
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Affiliation(s)
- Kellen T Krajewski
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Musculoskeletal Research Center, Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado
| | - Scott Miller
- Musculoskeletal Research Center, Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado
- Center for Gait and Movement Analysis (CGMA), Children's Hospital Colorado, Aurora, Colorado
| | - Radomir Dimovski
- Musculoskeletal Research Center, Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado
| | - Jason Rhodes
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Musculoskeletal Research Center, Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado
- Center for Gait and Movement Analysis (CGMA), Children's Hospital Colorado, Aurora, Colorado
| | - Sayan De
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Musculoskeletal Research Center, Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado
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Hassanein MY, Khaled M, Hassanein MY, Abol Oyoun N. Anterior Distal Femoral Hemiepiphysiodesis Using Coronally Oriented 8-plates for the Correction of Fixed Knee Flexion Deformities in Children-Preliminary Results. J Pediatr Orthop 2024:01241398-990000000-00579. [PMID: 38842294 DOI: 10.1097/bpo.0000000000002746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The original technique for guided growth of the distal femur for correction of pediatric fixed knee flexion deformities (FKFDs) involves the utilization of two 8-plates inserted on either side of the trochlear groove, a technique that has been frequently linked to the development of persistent postoperative knee pain and crepitus. The present study aimed to assess the preliminary results of a novel technique where the two 8-plates are fixed in the coronal plane, one on each of the medial and lateral surfaces, so that they occupy the anterior part of the distal femur. METHODS Our study was a prospective case series that included cases with FKFD of >10 degrees in children with at least 12 months of predicted growth remaining. The preoperative knee flexion contracture angle was documented. The surgical procedure entailed the insertion of 2 coronally oriented 8-plates on the medial and lateral surfaces of the distal femur as anterior as possible to the axis of the femur without encroachment on the trochlear groove. The duration of time required to attain full knee extension and any complications encountered were recorded. Wilcoxon signed-rank was used to compare the preoperative and final contracture angles. The level of statistical significance was set at P<0.05. RESULTS Thirteen knees in 8 patients (6 boys and 2 girls) were included. The median age was 11 years (6 to 14). There was a significant improvement in the FKFD for the whole cohort from 25 degrees (14 to 42) to 0 degrees (-9 to 8), P<0.05. The median rate of correction was 2.0 degrees/month (0.9 to 5.8). The time till full correction was 14 months (4 to 25). Postoperative knee pain and metalware-related complications were not reported by any patient during follow-up. CONCLUSIONS Guided growth of the distal femur using coronally oriented 8-plates is an effective procedure for the treatment of FKFDs in children. This modified technique may achieve faster correction while minimizing the risk of postoperative knee pain compared with the conventional technique. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Mohamed Y Hassanein
- Department of Orthopaedics and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt
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Al Badi H, Lorange JP, Alzeedi M, Marwan Y, Bernstein M, Hamdy RC. Distal Femur Anterior Hemiepiphysiodesis for Fixed Knee Flexion Deformity in Neuromuscular Patients: A Systematic Review. JBJS Rev 2023; 11:01874474-202306000-00003. [PMID: 37276266 DOI: 10.2106/jbjs.rvw.23.00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND In the past decade, distal femur anterior hemiepiphysiodesis for fixed knee flexion deformity has gained popularity. In this study, we aim to systematically review the literature on this technique as a treatment for fixed knee flexion deformity in patients with neuromuscular disorders. METHODS A systematic review was performed in the following databases: PubMed, Embase, and Medline. The inclusion criteria included anterior hemiepiphysiodesis of the distal femur for patients with neuromuscular disorders and fixed knee flexion deformities. RESULTS Our search yielded 419 titles. A total of 12 articles were qualified for final review based on the inclusion and exclusion criteria. The total number of patients was 279, with 483 knees corrected. The male to female ratio was 2.1:1, and the mean age of the patients was 11.3 ± 1.4 years (range 4-17 years). The mean preoperative flexion deformity was 23.1° ± 10.0° (range 10°-90°). The mean residual flexion deformity at the final follow-up was 8.6° ± 9.0° (range 0°-32.5°), which corresponds to a statistically significant decrease compared with the preoperative deformity (p < 0.05). CONCLUSION Anterior hemiepiphysiodesis for fixed knee flexion deformity provides favourable outcomes with low complication rates in patients with neuromuscular disorders. Future studies should focus on comparing the long-term outcomes of the different metal implants used for these operations. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hamid Al Badi
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Justin-Pierre Lorange
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Muadh Alzeedi
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yousef Marwan
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Mitchell Bernstein
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Reggie C Hamdy
- Limb Deformity Unit, Department of Pediatric Orthopaedic Surgery, Shriners Hospital for Children, Montreal, Quebec, Canada
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Stiel N, Babin K, Vettorazzi E, Breyer S, Ebert N, Rupprecht M, Stuecker R, Spiro AS. Anterior distal femoral hemiepiphysiodesis can reduce fixed flexion deformity of the knee: a retrospective study of 83 knees. Acta Orthop 2018; 89:555-559. [PMID: 29902104 PMCID: PMC6202731 DOI: 10.1080/17453674.2018.1485418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Fixed knee flexion deformity in children is a common problem in various diseases including myelomeningocele and cerebral palsy. Until now, only a few studies focusing on the surgical procedure of anterior distal femoral hemiepiphysiodesis have been published. We analyzed outcome and correction rate in the largest case series to date of patients treated by staples or 8-plates. Patients and methods - We reviewed the medical records of all patients with fixed knee flexion deformity who were treated with anterior distal femoral hemiepiphysiodesis using either staples or 8-plates between the years 2002 and 2017 (73 patients; 130 knees). 49 patients (83 knees) had completed treatment with implant removal at the time of full correction of the deformity or at skeletal maturity and were included. The average age at operation was 12 years (6-20). Patients were assigned to 3 different groups based on their diagnosis: cerebral palsy, myelomeningocele, and the "other" group.d Results - Mean fixed knee flexion deformity improved from 21° (10-60°) to 8° (0-50°) (p < 0.001) with an average correction rate of 0.44° per month (range -2.14° to 1.74°). The correction rate per month was lowest for patients with cerebral palsy (0.20°), followed by the myelomeningocele group (0.50°), and the "other" group (0.58°). Implant loosening occurred in 10% of the treated knees with consecutive re-implantation in 5% of the cases. Interpretation - Anterior distal femoral hemiepiphysiodesis is an effective and safe method for the treatment of fixed knee flexion deformity in children. The optimal timing depends on the remaining individual growth potential, the underlying disease, and the extent of the deformity.
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Affiliation(s)
- Norbert Stiel
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Kornelia Babin
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Breyer
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Nicola Ebert
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Martin Rupprecht
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Ralf Stuecker
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Alexander S Spiro
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany; ,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; ,Correspondence:
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Abstract
BACKGROUND Spina bifida is associated with congenital deformities, such as kyphosis, spinal malformations, teratological hip dislocations, clubfeet, vertical talus and also with acquired deformities due to muscle imbalance and impaired biomechanics. The degree of the acquired deformities and the mobility of the patient depend on the level of the spinal lesion. DIAGNOSTICS Neurological symptoms are mostly asymmetric and there is an inconsistent correlation between the anatomical level of the lesion and muscle function. Deficits of sensation are usually one to two levels lower than the motor level. An exact neurological diagnosis should not be made before the second or third year of life and an early prognosis about walking ability should be avoided. The level L3 and therefore function of the quadriceps is a functional milestone after which modified independent ambulation with the use of ankle foot orthoses (AFO) and crutches is possible. THERAPY The basic principle is to support verticalization and gait even when loss of ambulation is later expected. It is also important to support and maintain sitting ability for high lesions, if necessary with correction of the spinal deformity. Findings in gait analysis have shifted the focus of treatment from radiological criteria to functional improvement, thus maintenance of the flexibility of the hip is the main goal of hip surgery. Reduction of the hip often leads to stiffness and has a high redislocation rate. Clubfoot deformities should be treated early and foot arthrodesis and stiffness have to be avoided. Another focus is the prevention of joint contracture by early prophylactic treatment. CONCLUSION The purpose of management is to maximize the functional potential of the child. Subjective well-being, absence of pain, mobility and socialization are the main goals. This does not necessarily imply ambulation; nevertheless, verticalization and associated orthotic management is one major objective of the orthopedic management of spina bifida.
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Al-Oraibi S. Non-surgical Intervention of Knee Flexion Contracture in Children with Spina Bifida: Case Report. J Phys Ther Sci 2014; 26:793-5. [PMID: 24926155 PMCID: PMC4047255 DOI: 10.1589/jpts.26.793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 10/07/2011] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this case report is to describe for the first time, the use of
serial casting in the management of knee joint flexion contracture for a young child with
spina bifida. [Case Description] The child was 6 years old, and had L3–L4 spina bifida
level lesion with quadriceps muscle strength grade 3 +. The child had previously received
weekly physiotherapy including stretching for knee flexion contracture on both lower
limbs, but without improvement. [Results] The knee flexion contracture, which was not
corrected with passive stretching, improved with casting from −40° knee extension to −5°
knee extension as measured by a standard goniometer over a period of 4 weeks. Careful
measures were taken to ensure skin integrity. At follow up after one-year, the child could
ambulate independently with the help of walking aids. [Conclusion] The outcome indicates
that using serial casting and follow-up with the use of bracing may be useful for
enhancing the walking ability of a young child with spina bifida with knee flexion
contractures. Further investigations of serial casting as well as investigation of serial
casting with other interventions are warranted.
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Affiliation(s)
- Saleh Al-Oraibi
- Rehabilitation Department, Applied Medical Sciences College, King Saud University for Health Sciences, Saudi Arabia
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Kim YR, Kim JW, An DH, Yoo WG, Oh JS. Effects of a Pelvic Belt on the EMG Activity of the Abdominal Muscles during a Single-leg Hold in the Hook-lying Position on a Round Foam Roll. J Phys Ther Sci 2013; 25:793-5. [PMID: 24259855 PMCID: PMC3820407 DOI: 10.1589/jpts.25.793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 03/01/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the effects of a pelvic belt on the electromyography (EMG) activity of the abdominal muscles during a single-leg hold in the hook-lying position on a round foam roll. [Subjects] Seventeen healthy female volunteers were recruited for this study. [Methods] The participants performed single-leg-hold exercises on a round foam roll with and without a pelvic belt. Surface EMG was recorded from the rectus abdominis (RA), internal oblique (IO), and external oblique (EO) bilaterally. [Results] The EMG activity of the bilateral RA, EO, and IO was significantly lower when the pelvic belt applied. [Conclusions] Our finding that the bilateral EO, IO, and RA muscles were less active with a pelvic belt during trunk-stabilizing exercises on an unstable surface suggests that the pelvic belt provided "form closure".
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Affiliation(s)
- Yu-Ri Kim
- Department of Physical Therapy, Good Gang An Hospital
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Spiro AS, Stenger P, Hoffmann M, Vettorazzi E, Babin K, Lipovac S, Kolb JP, Novo de Oliveira A, Rueger JM, Stuecker R. Treatment of fixed knee flexion deformity by anterior distal femoral stapling. Knee Surg Sports Traumatol Arthrosc 2012; 20:2413-8. [PMID: 22307752 DOI: 10.1007/s00167-012-1915-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/23/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE The treatment of fixed knee flexion deformity through anterior distal femoral stapling has been investigated in only two studies so far, with promising results. The aim of the present study was to determine whether this technique might improve fixed knee flexion deformity in a series of growing children and adolescents with different conditions. Follow-up examinations were continued after staple removal in terms of a possible impairment of this deformity. METHODS We reviewed the medical records of all patients with fixed knee flexion deformity who had been treated by anterior distal femoral stapling at our institution. Twenty patients (37 knees) with a mean age of 12.7 years met the inclusion criteria (>12 months of follow-up; no additional procedures to correct fixed knee flexion deformity such as hamstring lengthening or posterior capsulotomy) and were evaluated in this study. RESULTS The mean fixed knee flexion deformity significantly improved from 21.4° (SD = 11.6) preoperatively to 7.0° (SD = 9.8) after a mean follow-up of 35.3 months. Young patients (<12 years) revealed superior improvement of this deformity, and especially children with distinct fixed knee flexion deformity of 30° or greater had benefit from early treatment. Impairment of flexion deformity was only seen in one patient (2 knees) after staple removal. CONCLUSIONS Our results demonstrate that anterior distal femoral stapling is an effective method for the treatment of fixed knee flexion deformity in growing children and adolescents. Rare complications, immediate mobilization, and a low recurrence rate after staple removal provide obvious advantages of this minimally invasive procedure. LEVEL OF EVIDENCE Retrospective therapeutic study, Level IV.
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Affiliation(s)
- Alexander S Spiro
- Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Abstract
BACKGROUND Knee flexion contracture leading to crouch gait is commonly seen in children with myelomeningocele. Progressive increase in knee flexion contracture increases energy cost, which interferes with efficient, functional ambulation. To prevent this, surgical release has been recommended when a knee flexion contracture exceeds 15° to 20°. QUESTIONS/PURPOSES We therefore asked whether knee flexion contracture release improved dynamic sagittal motion and walking velocity using computerized gait analysis. PATIENTS AND METHODS We retrospectively studied 11 patients (20 knees) with high-sacral-level or low-lumbar-level myelomeningocele and knee flexion contracture of greater than 15°. All patients underwent dynamic gait analysis pre- and postoperatively. Surgery consisted of selective hamstring lengthening (medial and lateral), gastrocnemius release from the femoral condyles, and posterior knee capsulectomy. RESULTS We observed improvements postoperatively in clinical measurements and sagittal kinematics. The clinical knee flexion contracture improved from a mean of 24.9° preoperatively to 5.9° postoperatively. The knee flexion at initial contact improved from 37.6° to 9.0°, and minimum knee flexion in single-leg stance improved from 48.2° to 16.4. Walking velocity improved from 72.2% to 80.0% of age-matched normal. CONCLUSIONS Surgical treatment of knee flexion contracture in patients with myelomeningocele using radical posterior knee capsulectomy leads to improvement in clinical knee flexion contracture, dynamic sagittal kinematics, and walking velocity.
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Anterior femoral epiphysiodesis for the treatment of fixed knee flexion deformity in spina bifida patients. J Pediatr Orthop 2010; 30:858-62. [PMID: 21102213 DOI: 10.1097/bpo.0b013e3181f10297] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fixed knee flexion deformity is a common problem in spina bifida patients. Owing to interference with ambulation, this deformity may lead to anterior knee pain and progressive crouch gait. If conservative treatment fails, surgical procedures including supracondylar femoral extension osteotomy, joint distraction, and posterior capsulotomy have to be considered. Potential complications of these procedures are fractures, neurovascular lesions, knee instability, and recurrent deformity with continued growth. As fixed knee flexion deformity in spina bifida patients frequently occurs bilaterally, this results in higher perioperative and postoperative risks and prolonged recovery, making these relatively invasive methods less appealing. In the skeletal immature patient, anterior femoral stapling is a feasible method to treat fixed knee flexion deformity as could be shown in an earlier study. In this study, anterior femoral stapling was performed in a series of patients with diverse etiologies, and the overall success rate was then calculated. The aim of this study was to determine whether anterior femoral epiphysiodesis may improve fixed knee flexion deformity in a group of spina bifida patients. METHODS Ten spina bifida patients with bilateral fixed knee flexion deformity (20 knees) were treated by anterior femoral epiphysiodesis through stapling. None of the patients received further knee procedures. The mean preoperative fixed knee flexion deformity was 20.3 ± 9.9 degrees (range: 10 to 40 degrees). Clinical and radiographic follow-up examinations were performed every 3 to 6 months after surgery. RESULTS All patients except 1 experienced significant improvement with a mean correction rate of 0.9 ± 0.5 degrees per month (range: 0.2 to 1.9 degrees). The residual flexion deformity averaged 5.3 ± 5.3 degrees (range: 0 to 15 degrees; P<0.001). CONCLUSIONS Anterior femoral epiphysiodesis through stapling is an effective and safe method for the treatment of fixed knee flexion deformity in growing children and adolescents with spina bifida. LEVEL OF EVIDENCE Therapeutic Study, Level IV.
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Swaroop VT, Dias L. Orthopedic management of spina bifida. Part I: hip, knee, and rotational deformities. J Child Orthop 2009; 3:441-9. [PMID: 19856195 PMCID: PMC2782071 DOI: 10.1007/s11832-009-0214-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 10/03/2009] [Indexed: 02/03/2023] Open
Abstract
Children with spina bifida develop a wide variety of congenital and acquired orthopedic deformities. Among these are hip deformities such as contracture, subluxation, or dislocation. Patients may also have problems with the knee joint, such as knee flexion or extension contracture, knee valgus deformity, or late knee instability and pain. In addition, rotational deformities of the lower extremities, either internal or external torsion, are common as well. This paper will review both the overall orthopedic care of a patient with spina bifida and provide a focused review of the diagnosis and management of the above deformities. In addition, this paper will review the incidence, etiology, classification, and prognosis of spina bifida. The use of gait analysis and orthoses will be covered as well. The forthcoming Part II will cover foot and ankle deformities in spina bifida.
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Affiliation(s)
- Vineeta T. Swaroop
- />Orthopedic Surgery, Northwestern University Feinberg School of Medicine, 345 E. Superior, #1132, Chicago, IL 60611 USA
| | - Luciano Dias
- />Orthopedic Surgery, Northwestern University Feinberg School of Medicine, 345 E. Superior, #1132, Chicago, IL 60611 USA , />Motion Analysis Center, Children’s Memorial Hospital, Chicago, IL USA
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Treatment of fixed knee flexion deformity and crouch gait using distal femur extension osteotomy in cerebral palsy. J Child Orthop 2008; 2:37-43. [PMID: 19308601 PMCID: PMC2656778 DOI: 10.1007/s11832-007-0073-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 11/17/2007] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the results of distal femur extension osteotomy and medial hamstring lengthening in the treatment of fixed knee flexion deformity in patients with spastic diparetic cerebral palsy. METHODS A retrospective study was done in a group of 12 diparetic cerebral palsy patients. A distal femur extension osteotomy was performed as part of multilevel surgery on lower limbs. The fixed knee flexion deformity was measured during physical examination, whereas hip and knee flexion in the stance phase and anterior pelvic tilt were both analyzed at kinematics. The pre- and post-surgery results were compared and analyzed statistically. A medical record review was done in order to identify the complications. The mean follow-up was 28 months. RESULTS A significant reduction of fixed knee flexion deformity at physical examination and knee flexion in the stance phase at kinematics was observed, but with no decrease in hip flexion. As a non-desired effect, there was an increase in anterior pelvic tilt after surgical procedures. With regard to complications, a single patient had skin breakdown at a calcaneous area on one side and the recurrence of deformity was seen in 27% of cases. CONCLUSIONS In this study, in which fixed knee flexion deformity did not exceed 40 degrees before surgery, the distal femur extension osteotomy was effective in increasing knee extension in the stance phase. However, an increase in anterior pelvic tilt, deformity recurrence and necessity for walking aids are possible complications of this procedure.
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