Long-term effects after conversion of biarticular to monoarticular muscles compared with musculotendinous lengthening in children with spastic diplegia

Dreher, Thomas; Végvári, Dóra; Wolf, Sebastian; Klotz, Matthias; Müller, Sebastian; Metaxiotis, Dimitrios; Wenz, W; Döderlein, Leonhard; Braatz, Frank

doi:10.1016/j.gaitpost.2012.08.020

Cited by 21 publications

(24 citation statements)

References 28 publications

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“…The electronic databases search produced 648 initial references of which 24 articles met the inclusion criteria ( Fig 1 ) [ 8 – 31 ]. Thirteen of the 24 articles reported on multiple follow-up assessments or different study cohorts [ 8 , 11 , 13 , 14 , 16 , 17 , 21 , 23 , 24 , 26 , 27 , 30 , 31 ], resulting in 50 different studies included in this systematic review.…”

Section: Resultsmentioning

confidence: 99%

“…Although all comparative studies used strict selection criteria, only two of these studies used factors to match their comparative groups. Thompson et al [ 31 ] matched the groups based on GMFCS levels (Level I-III), while Dreher et al [ 30 ] used primary (knee flexion and ankle dorsiflexion in stance) and secondary (pelvic tilt, hip flexion, age at surgery, body mass index (BMI), Gillette Gait Index (GGI) and GMFCS level) factors to match their two interventions groups.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 provides an overview of the 50 studies conducted within the 24 selected articles. All articles were published by a range of international research groups based in different countries (Austria (n = 7) [ 10 – 12 , 14 , 18 , 26 , 28 ], USA (n = 5) [ 16 , 17 , 19 , 20 , 22 ], Australia (n = 2) [ 15 , 21 ], Germany (n = 7) [ 8 , 13 , 23 , 24 , 27 , 29 , 30 ], Switzerland (n = 1) [ 9 ], France (n = 1) [ 25 ] and the United Kingdom (n = 1) [ 31 ]). The focus area of the SEMLS intervention ranged from General multi-level surgeries, Lever arm dysfunction, Multi-level tendon surgeries, Gait pattern to Operative techniques, which resulted in a variety of type of interventions as part of the SEMLS as presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Four articles [ 10 , 16 , 19 , 31 ] reported reference norm values for pelvic ROM (1–5°) and mean pelvic tilt (10–14°). After the SEMLS intervention, a change in pelvic ROM was found in 50% of the studies [ 10 , 12 , 19 , 29 ], while 24% of the studies [ 10 , 21 , 30 ] reported a significant change in mean pelvic tilt.…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Review of the Effects of Single-Event Multilevel Surgery on Gait Parameters in Children with Spastic Cerebral Palsy

et al. 2016

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BackgroundThree-dimensional gait analysis (3DGA) is commonly used to assess the effect of orthopedic single-event multilevel surgery (SEMLS) in children with spastic cerebral palsy (CP).PurposeThe purpose of this systematic review is to provide an overview of different orthopedic SEMLS interventions and their effects on 3DGA parameters in children with spastic CP.MethodsA comprehensive literature search within six databases revealed 648 records, from which 89 articles were selected for the full-text review and 24 articles (50 studies) included for systematic review. The Oxford Centre for Evidence-Based Medicine Scale and the Methodological Index for Non-Randomized Studies (MINORS) were used to appraise and determine the quality of the studies.ResultsExcept for one level II study, all studies were graded as level III according to the Oxford Centre for Evidence-Based Medicine Scale. The MINORS score for comparative studies (n = 6) was on average 15.7/24, while non-comparative studies (n = 18) scored on average 9.8/16. Nineteen kinematic and temporal-distance gait parameters were selected, and a majority of studies reported improvements after SEMLS interventions. The largest improvements were seen in knee range of motion, knee flexion at initial contact and minimal knee flexion in stance phase, ankle dorsiflexion at initial contact, maximum dorsiflexion in stance and in swing phase, hip rotation and foot progression angles. However, changes in 3DGA parameters varied based on the focus of the SEMLS intervention.DiscussionThe current article provides a novel overview of a variety of SEMLS interventions within different SEMLS focus areas and the post-operative changes in 3DGA parameters. This overview will assist clinicians and researchers as a potential theoretical framework to further improve SEMLS techniques within different SEMLS focus groups. In addition, it can also be used as a tool to enhance communication with parents, although the results of the studies can’t be generalised and a holistic approach is needed when considering SEMLS in a child with spastic CP.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A Systematic Review of the Effects of Single-Event Multilevel Surgery on Gait Parameters in Children with Spastic Cerebral Palsy

et al. 2016

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“…On the other hand, Dreher et al reported an increase of APT after the conversion of biarticular to monoarticular muscles and after musculotendinous lengthening in spastic diplegic CP in a long-term follow-up. 16 Feng et al in 2012 and De Mattos et al in 2014 compared the results of the transfer of semitendinosus and gracilis to distal femur to the lengthening of medial and lateral hamstrings. The improvement of knee extension in stance phase and the increase of APT were noted in both studies, irrespective of the techniques applied for the correction of KFD.…”

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confidence: 99%

Comparison between semitendinosus transfer to distal femur and medial hamstrings surgical lengthening for treatment of flexed knee gait in cerebral palsy

Filho¹,

Fujino²,

Blumetti³

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Hamstrings surgical lengthening (HSL) has been frequently used for the treatment of flexed knee gait in cerebral palsy; however, recurrence of knee flexion deformity (KFD) and increase of anterior pelvic tilt (APT) were reported in a long-term follow-up. Research question: The aim of this study was to compare semitendinosus transfer to distal femur (STTX) and semitendinosus surgical lengthening (STL) regarding the reduction of KFD and the increase of APT after flexed knee gait treatment. Methods: One hundred and eleven patients were evaluated and they were divided into two groups according to surgical procedures at knees: group A (65 patients/130 knees), including patients who received medial HSL as part of multilevel approach; group B (46 patients/92 knees), represented by patients who underwent orthopedic surgery including an STTX instead of STL. Results: Fixed knee flexion deformity (FKFD) decreased only in group B (from 6.79° to 2.96°, p < 0.001) after intervention. In kinematics, APT increased from 16.38° to 19.03° in group A ( p = 0.003), while group B also increased from 15.26° to 20.59° ( p < 0.001). The minimum knee flexion in stance phase (MKFS) reduced from 25.34° to 21.65° ( p = 0.016) in group A and from 31° to 19.57° ( p < 0.001) in group B. In the comparison between groups A and B, the increase of APT ( p = 0.028) and reduction of FKFD ( p < 0.001), popliteal angle ( p = 0.001), bilateral popliteal angle ( p = 0.003) and MKFS ( p = 0.006) were higher after STTX than STL. Conclusion: In the present study, patients who received STTX exhibited more improvement of knee extension at clinical examination and during gait than those who underwent to STL; however, STTX was not effective to prevent the increase of APT after flexed knee gait treatment.

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Knee Flexion Deformity in Cerebral Palsy

Miller¹

2018

Cerebral Palsy

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Long-term effects after conversion of biarticular to monoarticular muscles compared with musculotendinous lengthening in children with spastic diplegia

Cited by 21 publications

References 28 publications

A Systematic Review of the Effects of Single-Event Multilevel Surgery on Gait Parameters in Children with Spastic Cerebral Palsy

A Systematic Review of the Effects of Single-Event Multilevel Surgery on Gait Parameters in Children with Spastic Cerebral Palsy

Comparison between semitendinosus transfer to distal femur and medial hamstrings surgical lengthening for treatment of flexed knee gait in cerebral palsy

Knee Flexion Deformity in Cerebral Palsy

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