Postoperative Gait Velocity and Mean Knee Flexion in Stance of Ambulatory Children With Spastic Diplegia Four Years or More After Multilevel Surgery

Abstract

Factors associated with longer-term outcomes of multilevel orthopaedic surgery in ambulatory children with cerebral palsy using a multivariate approach were evaluated using a retrospective pretest-posttest design. The population included 20 ambulatory children with spastic diplegia who had undergone multilevel orthopaedic surgery with a minimum of 4-year interval between a preoperative and a postoperative gait assessment. Multiple regression analysis was used to identify factors associated with postoperative velocity and mean knee flexion in stance. Independent variables included in the regression models were velocity, mean knee flexion in stance, age at preoperative evaluation, Gross Motor Function Classification System level, use of ankle-foot orthoses, leg length, age-adjusted body mass index, number of surgical procedures, and range of motion of hip and knee. Children who demonstrated faster postoperative gait velocity 4 years or more after surgery were younger at the time of initial evaluation, had undergone fewer surgical procedures, had faster preoperative gait velocity, used ankle-foot orthoses postoperatively, and had increased hip extension range of motion postoperatively (R = 0.55). Children who demonstrated greater knee flexion in stance 4 years or more after surgery had undergone more surgical procedures, greater postoperative popliteal angle, and less knee extension range of motion (R = 0.73). This study demonstrates the usefulness of a multivariate approach toward understanding and predicting outcomes. The results of this study will provide clinicians and researchers more information about those factors associated with maintained improvements in the longer term and may be useful for treatment planning.

Modified Goal Attainment Scale outcomes for ambulatory children: With and without orthopedic surgery

“…A large percentage of subjects seen in clinical motion laboratories have a diagnosis of cerebral palsy (CP). Several research studies have examined outcomes following surgical intervention using a variety of different standardized tests and quantitative measures [14][15][16][17][18][19]. Gates et al [20] investigated the functional changes between children with spastic diplegia undergoing surgery versus those with non-surgical treatment.…”

Walking abilities of young adults with cerebral palsy: Changes after multilevel surgery and adolescence

“…Analysis of individual gait parameters, such as gait velocity or mean knee flexion in stance would likely reveal different results [7,24]. As overall walking abilities were of interest, using GGI is an appropriate outcome measure.…”

“…In the longer term (more than 3 years follow up) however, it can be difficult to predict who will benefit the most from surgical intervention and few studies have attempted to look beyond 3 years. Adolfsen et al [6] and Gannotti et al [7] identified children with crouch who have maintained surgical gains at the knee 4 years post-operatively. There is little evidence to support continued or maintained improvement of function into adulthood [8].…”

What Is the Best Treatment for Ambulatory Cerebral Palsy?

“…These studies are typically small, retrospective, uncontrolled case series looking at preintervention and postintervention comparisons that demonstrate some improvements in the short term in outcomes limited to the level of body structures and body functions, such as range of motion, spatiotemporal gait parameters, and kinematic or kinetic improvements on gait analysis. 18,59,[79][80][81] The clinical signifi cance of these fi ndings is less clear, with only a few case series (Level IV evidence) reporting benefi ts in some functional outcomes at the level of activities and participation. [80][81][82][83][84] A few retrospective, case-control or cohort studies (Level III evidence) compare different surgical techniques, but few prospective clinical trials compare the effectiveness of these procedures.…”