Coronal Plane Knee Moments Improve After Correcting External Tibial Torsion in Patients With Cerebral Palsy

Aiona, Michael D.; Calligeros, Kosta; Pierce, Rosemary

doi:10.1007/s11999-011-2219-x

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…Accordingly, many researchers stress the necessity of proper lower-limb segmental alignment in the transverse plane for producing the internal plantar ﬂexor moment that facilitates knee extension in single support, and improves the kinematic and kinetic gait deviations. 26–28…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, many researchers stress the necessity of proper lowerlimb segmental alignment in the transverse plane for producing the internal plantar flexor moment that facilitates knee extension in single support, and improves the kinematic and kinetic gait deviations. [26][27][28] A dynamic splinting is certainly a viable and useful physical therapy intervention tool for modulating biomechanical mal-alignment and poor postural control in children having cerebral palsy. Many researchers proposed that therapeutic strapping would provide the foundation for increasing proprioceptive and tactile awareness, restoring optimal muscle length to provide a basis for normal firing and recruitment patterns and orienting the muscle force along normal vectors in the frontal and sagittal planes.…”

Section: Variablementioning

confidence: 99%

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The clinical impact of orthotic correction of lower limb rotational deformities in children with cerebral palsy: a randomized controlled trial

El-Kafy

2014

Clin Rehabil

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Section: Discussionmentioning

confidence: 99%

Section: Variablementioning

confidence: 99%

The clinical impact of orthotic correction of lower limb rotational deformities in children with cerebral palsy: a randomized controlled trial

El-Kafy

2014

Clin Rehabil

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“…The mechanical loading of an externally or internally deviated foot is atypical, and thus believed to be a contributing factor to progressive foot deformity (2). Finally, foot progression deviations can cause atypical loading of the knee joint in the coronal and transverse planes, which could, over time, hasten or worsen degenerative knee conditions such as osteoarthritis (3,4).…”

Section: Introductionmentioning

confidence: 99%

Estimating Causal Treatment Effects of Femoral and Tibial Derotational Osteotomies on Foot Progression in Children with Cerebral Palsy

Schwartz

Kainz

Georgiadis

2021

Preprint

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Background Foot progression deviations are a common and important problem for children with CP. Tibial and femoral derotational osteotomies (TDO, FDO) are used to treat foot progression deviations, but outcomes are unpredictable. The available evidence for the causal effects of TDO and FDO is limited and weak, and thus modeling approaches are needed. Methods We queried our clinical database for individuals with a diagnosis of cerebral palsy (CP) who were less than 18 years old and had baseline and follow up gait data collected within a 3-year time span. We then used the Bayesian Causal Forest (BCF) algorithm to estimate the causal treatment effects of TDO and FDO on foot progression deviations (separate models). We examined average treatment effects and heterogeneous treatment effects (HTEs) with respect to clinically relevant covariates. Results The TDO and FDO models were able to accurately predict follow-up foot progression (r2 ~0.7, RMSE ~8[&deg]). The estimated causal effect of TDO was bimodal and exhibited significant heterogeneity with respect to baseline levels of foot progression and tibial torsion as well as changes in tibial torsion at follow-up. The estimated causal effect of FDO was unimodal and largely homogeneous with respect to baseline or change characteristics. Conclusions This study demonstrated the potential for causal machine-learning algorithms to impact treatment in children with CP. The causal model is accurate and appears sensible, though no gold-standard exists for validating the causal estimates. The model results can provide guidance for planning surgical corrections, and partly explain unsatisfactory outcomes observed in prior observational clinical studies.

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“…In their study, they found that older age and higher GMFCS level were the most significant predictors for increased external tibial torsion. Thus, significant increases in external rotation at TMA and in tibial rotation during gait in the longer term after both MHL and MLHL are likely related to a trend present with growth in children with CP rather than directly related to the surgical intervention [34,45,46]. Similarly, in a study evaluating external tibial derotation osteotomies in children with spastic CP to address internal tibial rotation and crouch gait, there was a tendency for overcorrection of internal rotation at long-term follow-up [46].…”

Section: Discussionmentioning

confidence: 99%

The effect of medial only versus medial and lateral hamstring lengthening on transverse gait parameters in cerebral palsy

Bezuidenhout

Church

Henley

et al. 2023

Journal of Pediatric Orthopaedics B

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Benefits of hamstring lengthening surgery on the sagittal plane in children with cerebral palsy have been previously demonstrated, but there is limited information on its effects on the transverse plane. This study compared the effects of medial hamstring lengthening (MHL) with those of medial and lateral hamstring lengthening (MLHL) procedures in the transverse plane. Children with gross motor function classification system (GMFCS) levels I-III who had MHL or MLHL were included. Baseline, short-(1-2 years), and long-term (3+ years) postoperative threedimensional gait analysis outcomes were compared using analysis of variance. Children were excluded if they had concurrent osteotomies or tendon transfers. One hundred fifty children (235 limbs) were included, with 110 limbs in the MHL group (age 8.5 ± 4.1 years, GMFCS I-27%, II-52%, and III-21%) and 125 limbs in the MLHL group (age 10.0 ± 4.0 years, GMFCS I-23%, II-41%, and III-37%). Time between surgery and short-and long-term follow-up gait analysis was 1.5 ± 0.6 years and 6.6 ± 2.9 years, respectively. Transmalleolar axis became more external after MHL at both short and long terms (P < 0.05), whereas there were only significant differences at long term in MLHL (P < 0.05). Although hamstring lengthening has a positive impact on stance phase knee extension in children with cerebral palsy, intact lateral hamstrings after MHL likely contribute to increased tibial external rotation after surgery. Significant increases in external rotation at the knee in the long term are likely related to a trend present with growth in children with cerebral palsy rather than a direct result of surgical intervention.

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Coronal Plane Knee Moments Improve After Correcting External Tibial Torsion in Patients With Cerebral Palsy

Cited by 14 publications

References 25 publications

The clinical impact of orthotic correction of lower limb rotational deformities in children with cerebral palsy: a randomized controlled trial

The clinical impact of orthotic correction of lower limb rotational deformities in children with cerebral palsy: a randomized controlled trial

Estimating Causal Treatment Effects of Femoral and Tibial Derotational Osteotomies on Foot Progression in Children with Cerebral Palsy

The effect of medial only versus medial and lateral hamstring lengthening on transverse gait parameters in cerebral palsy

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