Orthopaedic management of knee joint impairment in cerebral palsy: A systematic review and meta-analysis

Campbell, Ryan; Tipping, Nicholas; Carty, Christopher P.; Walsh, John P.; Johnson, Liam

doi:10.1016/j.gaitpost.2020.06.020

Cited by 8 publications

(5 citation statements)

References 94 publications

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“…Failure of these therapy modalities occurs more frequently in children with fixed knee deformities compared to those with dynamic deformities. 7 Surgical management is often required when conservative treatment for FKFD fails to improve knee range of motion (ROM). 8 Traditional surgical treatment for correction of fixed angular knee deformities has been distal femoral extension osteotomy (DFEO).…”

Section: Introductionmentioning

confidence: 99%

Anterior distal femoral hemiepiphysiodesis with and without patellar tendon shortening for fixed knee flexion contractures in children with cerebral palsy

Rethlefsen

Hanson

Wren

et al. 2020

Journal of Children's Orthopaedics

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Purpose Surgery is often required for fixed knee flexion contractures in patients with neuromuscular conditions. Anterior distal femoral hemiepiphysiodesis (ADFH) is an alternative to distal femoral extension osteotomy (DFEO) in skeletally immature patients. ADFH is typically not accompanied by patellar tendon shortening surgery (PTS). Our purpose was to compare ADFH alone versus ADFH with PTS for treatment of fixed knee flexion contractures and crouched gait in children with cerebral palsy (CP). Methods Retrospective review of pre- and postoperative gait analysis data for children with CP who underwent ADFH alone, or ADFH with PTS. Data were analysed using linear mixed models to control for covariates. Results In total, 25 participants (42 limbs) were included, 17 male and eight female, mean age at surgery 12.9 (sd 1.9) years. Both groups experienced significant improvement in popliteal angle, knee extension range of motion (ROM) and knee extension in stance phase. Greater improvement was seen for all variables in the ADFH/PTS group, mainly due to greater popliteal angle and knee flexion during gait preoperatively in that group (p ≤ 0.02) rather than the procedure performed (p ≥ 0.19). There was no difference between groups postoperatively. Rate of contracture resolution was 0.5° to 1.0° per month, faster in larger contractures (p = 0.02). Conclusions ADFH with and without PTS is effective in improving knee extension in skeletally immature patients with CP, correcting contractures at a rate of 0.5° to 1.0° per month. Combined ADFH and PTS surgery may be preferable in patients with larger contractures of up to 30° to 35°. Level of evidence III

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Section: Introductionmentioning

confidence: 99%

Anterior distal femoral hemiepiphysiodesis with and without patellar tendon shortening for fixed knee flexion contractures in children with cerebral palsy

Rethlefsen

Hanson

Wren

et al. 2020

Journal of Children's Orthopaedics

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“…Improvements in the range of motion were mainly sought through lengthening or transferring the rectus muscle, so as to reduce its straightening effect on the knee joint in this phase of movement, and thereby improve the kinematics and velocity of movement [27]. Meta-analysis shows the ineffectiveness of such treatment [28],…”

Section: Discussionmentioning

confidence: 99%

Czynniki ograniczające zgięcie stawu kolanowego podczas chodu u dziecka z mózgowym porażeniem

et al. 2022

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“…The transfer or lengthening of the rectus femoris muscle is the most common orthopedic procedure to increase knee flexion during the swing phase of walking [ 38 , 39 , 40 ]. Theoretically, it was assumed that the transfer of RF and changing its function from knee extensor to flexion should increase the knee flexion ROM [ 39 ]; however, the mechanism and benefits of the surgery were recently seriously questioned [ 18 , 41 , 42 ]. Most likely, the lengthening of the RF and reducing knee extensors force led to the improvement in flexion [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…The results of the treatment are not consistently successful [ 14 , 15 , 16 , 17 ]. Campbell et al reported that the intervention is ineffective based on their meta-analysis [ 18 ]. Inconsistency in reported effectiveness seems to be dependent on the individual’s status.…”

Section: Introductionmentioning

confidence: 99%

Contribution of Different Impairments to Restricted Knee Flexion during Gait in Individuals with Cerebral Palsy

Manikowska

Brazevič

Jóźwiak

et al. 2022

JPM

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The coexistence of overlapping impairments modulates the knee pattern in the swing phase of walking in children with cerebral palsy (CP). The impact and contribution of each impairment to the reduction of knee range-of-motion is unknown. The aim of the study was to establish the gradation of the impact of individual coexisting impairments on the knee flexion range-of-motion. Passive range-of-motion, selective motor control, strength, and spasticity from 132 patients (Male = 76, Female = 56, age:11 ± 4 years) with spastic CP were tested with clinical tools. Knee flexion range-of-motion at terminal stance, pre-swing, and initial swing phases were assessed by gait analysis. Hypertonia (β = −5.75) and weakness (β = 2.76) of knee extensors were associated with lower range of knee flexion (R2 = 0.0801, F = 11.0963, p < 0.0001). The predictive factors (R2 = 0.0744, F = 7.2135, p < 0.0001) were strength (β = 4.04) and spasticity (β = −2.74) of knee extensors and strength of hip flexors (β = −2.01); in swing those were knee extensors hypertonia (β = −2.55) and passive range of flexion (β = 0.16) (R2 = 0.0398, F = 3.4010, p = 0.01). Hypertonia of knee extensors has the strongest impact on knee flexion range-of-motion; secondary is the strength of knee extensors. The knee extensors strength with knee extensors hypertonia and strength of hip flexors contributes in stance. Knee extensors hypertonia with passive knee flexion range-of-motion contributes in swing.

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Orthopaedic management of knee joint impairment in cerebral palsy: A systematic review and meta-analysis

Cited by 8 publications

References 94 publications

Anterior distal femoral hemiepiphysiodesis with and without patellar tendon shortening for fixed knee flexion contractures in children with cerebral palsy

Anterior distal femoral hemiepiphysiodesis with and without patellar tendon shortening for fixed knee flexion contractures in children with cerebral palsy

Czynniki ograniczające zgięcie stawu kolanowego podczas chodu u dziecka z mózgowym porażeniem

Contribution of Different Impairments to Restricted Knee Flexion during Gait in Individuals with Cerebral Palsy

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