Common Gait Abnormalities of the Knee in Cerebral Palsy

Sutherland, David H.; Davids, Jon R.

doi:10.1097/00003086-199303000-00018

Cited by 220 publications

(284 citation statements)

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“…This gait pattern was described by Sutherland and Davids [17] as an excessive knee extension throughout swing phase with variable alignment in stance. Prolongation of phasic, late stance, rectus femoris (RF) activity into swing phase constitutes an EMG pattern commonly associated with stiffknee gait [13,17,18,20]. RF proximal or distal release is said to improve knee flexion in patients with stiff-knee gait and abnormal RF activity in swing phase [18,20].…”

Section: Introductionmentioning

confidence: 92%

Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia

Presedo

Mégrot²,

Ilharreborde

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Children with spastic diplegia frequently show excessive knee extension (stiff-knee gait) throughout swing phase, which may interfere with foot clearance. Abnormal rectus femoris activity is commonly associated with a stiff-knee gait. Rectus femoris transfer has been recommended to enhance knee flexion during swing. However, recent studies suggest the transfer does not generate a knee flexor moment but diminishes knee extension moment in swing and MRI studies show the transferred tendons can be constrained by scarring to underlying muscles. Thus, it is possible knee flexion would be improved by distal rectus release rather than transfer since it would not be adherent to the underlying muscles. Questions/purposes We therefore determined whether rectus femoris distal tendon resection improves knee ROM and kinematic characteristics of stiff-knee gait in patients with spastic diplegia. Patients and MethodsWe studied 45 patients who underwent rectus femoris distal tendon resection as a part of multilevel surgery. Rectus femoris procedures were indicated based on kinematic characteristics of stiff-knee gait. All patients were walkers and had a mean age at surgery of 13 years (range, 6-22 years). We obtained gait analyses before surgery and at mean 2-year followup. We based postoperative assessment on clinical evaluation and gait analysis data. Results At followup, rectus femoris distal tendon resection was associated with improved knee ROM and timing of peak knee flexion in swing, and the absolute values of peak knee flexion became normal for those patients who showed abnormal preoperative values.

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Section: Introductionmentioning

confidence: 92%

Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia

Presedo

Mégrot²,

Ilharreborde

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…The results are development of crouch gait, increase of energetic expenditure and anterior knee pain [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Treatment of fixed knee flexion deformity and crouch gait using distal femur extension osteotomy in cerebral palsy

Filho

Neves

Abreu

et al. 2008

Journal of Children's Orthopaedics

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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°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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“…Мы признаем, что отсутствие в Центре имени академика Г.А. Илизарова лаборатории анализа походки, являющейся «золотым» стандартом количественной оценки [14,17,19,20], не дает возможности оценки кинематических показателей в совокупности с кинетическими и динамическими электромиографическими параметрами. В итоге, все положительные изменения в ортопеди-ческом статусе суммировались в улучшение функцио-нальных возможностей по опроснику Gillette [7,12] с VI уровня (пациент способен пройти более 4,5-15 ме-тров вне дома, но использует обычно инвалидное крес-ло для перемещений на улице и общественных местах) до VIII уровня (пациент перемещается вне дома само-стоятельно по ровной поверхности и преодолевает сту-пеньки и неровности, но требуется помощь или лишь наблюдение третьих лиц).…”

Section: клинический примерunclassified

“…Однако не всегда удается получить желаемый результат в отдаленном периоде наблюдения. Выполнение рекон-структивных вмешательств в рамках многоуровневых одномоментных операций позволяет улучшить многие параметры как статического ортопедического статуса, так и показателей походки, что, в целом, повышает функ-циональные возможности ребенка [19,20].…”

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Foot deformity correction according to Evans technique in a child with cerebral palsy within performing the acute multilevel orthopedic intervention. A case report

Leonchuk¹,

Chibirov²,

Popkov³

2016

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Common Gait Abnormalities of the Knee in Cerebral Palsy

Cited by 220 publications

References 0 publications

Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia

Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia

Treatment of fixed knee flexion deformity and crouch gait using distal femur extension osteotomy in cerebral palsy

Foot deformity correction according to Evans technique in a child with cerebral palsy within performing the acute multilevel orthopedic intervention. A case report

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