PurposeHip surveillance programmes for children with cerebral palsy (CP) utilize the migration percentage (MP) measurement to initiate referrals and recommend treatment. This study assesses the reliability and efficiency of three methods of MP measurement on anteroposterior (AP) pelvis radiographs.MethodsA total of 20 AP pelvis radiographs (40 hips) of children with CP were measured by three raters on two occasions using three methods: digital measurement (DM) on a Picture Archiving and Communication System monitor, computer-aided measurement (CA) using a digital templating tool and mobile device application measurement (MA) using a freely available MP measurement tool. For each method, the time required to complete the MP measurement of both hips on each AP pelvis radiograph was measured. Intra-class correlation coefficient (ICC) was used to determine reliability, and analysis of variance was used to compare groups.ResultsAll three methods of determining MP showed excellent inter-rater and intra-rater reliability (ICC 0.976 to 0.989). The mean absolute difference in MP measurement was not significant between trials for a single rater (DM 2.8%, CA 1.9%, MA 2.2%) or between raters (DM 3.6%, CA 2.9%, MA 3.6%). The mean time to complete MP measurement was significantly different between methods, with DM = 151 seconds, CA = 73 seconds and MA = 80 seconds.ConclusionAll three MP measurement methods were highly reliable with clinically acceptable measurement error. The time required to measure a hip surveillance radiograph can be reduced by approximately 50% by utilizing a computer-based or mobile application-based MP measurement tool.Level of Evidence III

Background and Objective(s): It is widely assumed that muscles are weaker following surgical lengthening in children with cerebral palsy (CP). An alternative technique, "slow surgical lengthening" (SSL, pure aponeurotic lengthening without disruption of the underlying muscle belly, followed by gentle positional stretching over time) has been developed based upon modern understanding of skeletal muscle myoarchitecture and physiology. The goal of the study was to assess the strength of the knee flexor (agonist) and extensor (antagonist) muscle groups following SSL of the medial hamstring muscles (MHM). Study Design: Retrospective, consecutive case series (cohort study). Study Participants & Setting: Thirty children with CP (GMFCS I [16] or II [14], mean age 10.1 y) who received SSL of the MHM as part of single event multi-level surgery, who had muscle strength testing pre-and post-operatively (mean time from surgery to post-operative gait analysis was 1 y + 2 mo) as part of a comprehensive gait analysis were included. Materials/Methods: Isometric and isokinetic testing of the knee flexor and extensor muscle groups were performed with the subject seated with 90 degrees of hip flexion utilizing a Biodex System 3. Isometric knee flexor and extensor testing occurred at 30 and 90 degrees of knee flexion, respectively. Isokinetic testing occurred through the subject's active knee range of motion at 60 degrees per second. Results: Isometric strength was unchanged for knee flexor and extensor muscle groups, (p = 0.555, 0.955 respectively) and isokinetic strength was significantly improved for both the knee flexor and extensor muscle groups (p = 0.003, 0.004, respectively) following SSL of the MHM (Table 1).

Background: Patient-Reported Outcomes Measurement Information System (PROMIS) is a well-validated tool used to measure health-related quality of life for children and adolescents with chronic medical conditions. The current study evaluates PROMIS scores in 3 domains for children with Ponseti-treated idiopathic clubfoot. Methods: This is a retrospective cohort study of 77 children, ages 5 to 16 years, treated by Ponseti protocol for idiopathic clubfoot. Three pediatric PROMIS domains (Mobility, Pain Interference, and Peer Relationships) were administered between April 2017 and June 2018. One-way analysis of variance with Bonferroni post hoc and independent sample t tests were performed to explore differences across PROMIS domain scores by sex, age, initial Dimeglio score, laterality, bracing duration, and whether the child underwent tibialis anterior transfer. Results: In the self-reported group (ages 8 to 16), mean T-scores for all 3 domains in both unilaterally and bilaterally affected groups were within the normal range, with respect to the general reference pediatric population. However, children with unilateral clubfoot had a significantly higher mean Mobility T-score (54.77) than children with bilateral clubfoot (47.81, P=0.005). Children with unilateral clubfoot also had significantly lower mean pain scores (39.16) than their bilateral counterparts (46.56, P=0.005). Children who had braced >36 months had a significantly higher mean Mobility T-score (53.68) than children who braced ≤36 months (46.28, P=0.004). In the proxy group (ages 5 to 7), mean T-scores for all 3 domains in both laterality groups were within the normal range, with respect to the reference population. Children who had braced >36 months had a significantly higher mean Mobility T-score (52.75 vs. 49.15, P=0.014) and lower Pain Interference score (43.04 vs. 49.15, P=0.020) than children who braced ≤36 months. Conclusions: Children treated by Ponseti protocol for idiopathic clubfoot yielded PROMIS scores for Mobility, Pain Interference, and Peer Relationships domains similar to the reference population. Bracing duration >36 months and unilaterality were associated with less mobility impairment than their counterparts. These findings may help guide parent recommendations. Level of Evidence: Level III.

Diagnostic level II.