Avulsion of the distal pole of the patella in cerebral palsy. A cause of deteriorating gait

Lloyd-Roberts, G. C.; Jackson, AM; Albert, JS

doi:10.1302/0301-620x.67b2.3980536

Cited by 35 publications

(14 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This increase in required muscle force is consistent with experimental studies that show greater muscle activity in flexed postures (Hsu et al 1993) and reports of increased energy expenditure for crouch gait (Rose et al 1990;Waters and Mulroy 1999). Larger muscle forces also increase joint loading, a likely contributor to knee abnormalities, like patella alta, observed in patients who walk with crouch gait for extended time periods (Rosenthal and Levine 1977;Lloyd-Roberts et al 1985). The progressive reduction in muscle extension capacities with increasing crouch severity suggests that subjects may enter a downward cycle once they start to develop crouch, as observed in clinical settings (Sutherland and Cooper 1978;Bell et al 2002).…”

Section: Discussionsupporting

confidence: 85%

“…Walking with a crouch gait increases the energy costs of walking (Campbell and Ball 1978;Waters and Lunsford 1985;Rose et al 1990) and can lead to joint pain and degeneration (Rosenthal and Levine 1977;Lloyd-Roberts et al Please direct correspondence to: Jennifer Hicks, M.S., Clark Center, Room S341, Stanford University, Mail Code 5450, 318 Campus Drive, Stanford CA 94305, Phone: 650-725-5101, Fax: 650-724-1922, Email: jenhicks@stanford.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait

Hicks

Schwartz

Arnold

et al. 2008

Journal of Biomechanics

140

106

View full text Add to dashboard Cite

Many children with cerebral palsy walk in a crouch gait that progressively worsens over time, decreasing walking efficiency and leading to joint degeneration. This study examined the effect of crouched postures on the capacity of muscles to extend the hip and knee joints and the joint flexions induced by gravity during the single limb stance phase of gait. We first characterized representative mild, moderate, and severe crouch gait kinematics based on a large group of subjects with cerebral palsy (N = 316). We then used a three-dimensional model of the musculoskeletal system and its associated equations of motion to determine the effect of these crouched gait postures on (1) the capacity of individual muscles to extend the hip and knee joints, which we defined as the angular accelerations of the joints, towards extension, that resulted from applying a 1 N muscle force to the model, and (2) the angular acceleration of the joints induced by gravity. Our analysis showed that the capacities of almost all the major hip and knee extensors were markedly reduced in a crouched gait posture, with the exception of the hamstrings muscle group, whose extension capacity was maintained in a crouched posture. Crouch gait also increased the flexion accelerations induced by gravity at the hip and knee throughout single limb stance. These findings help explain the increased energy requirements and progressive nature of crouch gait in patients with cerebral palsy.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait

Hicks

Schwartz

Arnold

et al. 2008

Journal of Biomechanics

140

106

View full text Add to dashboard Cite

show abstract

“…The patellofemoral, in contrast to the tibiofemoral, joint was the most affected in the patients with CP, which agrees with the fact that clinically patients with CP frequently have patellofemoral joint dysfunction [11,13,21,23], limited knee extension strength, and spasticity, all of which contribute to long-term mobility impairments. This could have serious consequences for knee pain and integrity.…”

Section: Discussionsupporting

confidence: 77%

Three-dimensional In Vivo Quantification of Knee Kinematics in Cerebral Palsy

Sheehan

Seisler

Alter

2008

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Cerebral palsy is the most common disabling condition in childhood, involving a diverse group of movement and posture disorders of varying etiologies. Yet, much is unknown about how cerebral palsy affects individual joints because currently applied techniques cannot quantify the three-dimensional kinematic parameters at the joint level. We quantified the effects of cerebral palsy at the knee using fast phase contrast MRI, with the ultimate intent of improving the assessment of joint impairments associated with cerebral palsy, improving clinical outcomes, and reducing the impact of cerebral palsy on function. We addressed three questions: (1) Can patients with cerebral palsy perform the required repetitive extension task? (2) Which of the 12 degrees of freedom defining complete knee kinematics are abnormal in individual patients with cerebral palsy and is the patellar tendon moment arm abnormal in these patients? (3) Are the individual kinematic differences consistent with clinical observations? All patients were able to perform the required task. We found kinematic differences for each patient with cerebral palsy consistent with clinical findings, in comparison to an able-bodied population. Fast phase contrast MRI may allow differentiation of patellofemoral and tibiofemoral function in various functional subtypes of cerebral palsy, providing insights into its management.

show abstract

“…14 It is commonly transverse and is seen in athletes as well as in patients with cerebral palsy who overload the patella by walking with a crouch gait. 15 It is a mistake to assume that deteriorating gait in a spastic who is entering the teenage years is due simply to Radiographs of a 12-year-old boy showing a) a widely displaced sleeve fracture and b) the opposite knee with the characteristic bipartite lower pole. Separation occurs through the line of the synchondrosis.…”

Section: Distinct Causes Of Anterior Knee Painmentioning

confidence: 99%

Anterior Knee Pain

Jackson

2001

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

Avulsion of the distal pole of the patella in cerebral palsy. A cause of deteriorating gait

Abstract: II Side affected Bilateral Neurological type Spastic diplegia Spastic tetraplegia Myelomeningocele and hypertonia 4 I I 3 Spastic tetraplegia

Cited by 35 publications

References 0 publications

Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait

Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait

Three-dimensional In Vivo Quantification of Knee Kinematics in Cerebral Palsy

Anterior Knee Pain

Contact Info

Product

Resources

About