Prevalence of knee contractures is high in children with cerebral palsy in Denmark

Klenø, André N; Stisen, Martin B; Cubel, Claes Høgh; Mechlenburg, Inger; Nordbye-Nielsen, Kirsten

doi:10.1080/09593985.2021.2007558

Physiotherapy Theory and Practice

2021

DOI: 10.1080/09593985.2021.2007558

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Prevalence of knee contractures is high in children with cerebral palsy in Denmark

André N Klenø

Martin B Stisen

Claes Høgh Cubel

et al.

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Cited by 3 publications

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“…Fixed knee flexion deformities are a common orthopaedic problem for children with cerebral palsy (CP) 1–3 . These deformities can contribute to flexed knee gait 4 which leads to decreased gait efficiency and can contribute to knee pain 5 .…”

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confidence: 99%

“…Key Words: anterior distal hemiepiphysiodesis, anterior pelvic tilt, flexed knee gait, fixed knee flexion deformities, cerebral palsy (J Pediatr Orthop 2024;44:76-81) F ixed knee flexion deformities are a common orthopaedic problem for children with cerebral palsy (CP). [1][2][3] These deformities can contribute to flexed knee gait 4 which leads to decreased gait efficiency and can contribute to knee pain. 5 There are several surgical options in the treatment of fixed knee flexion deformities and flexed knee gait, including distal femoral extension osteotomy with or without patellar tendon shortening/advancement, [6][7][8] patella tendon shortening/advancement alone, 9,10 hamstring lengthening (HSL), 11,12 hamstring transfer, 13,14 anterior distal femoral hemiepiphysiodesis (ADFH), 15,16 or a combination of bony and soft tissue procedures 17 with improvement in static and dynamic knee extension reported.…”

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Anterior Distal Femoral Hemiepiphysiodesis Does Not Change Pelvic Tilt in Children With Cerebral Palsy

Hanson,

Wren,

Rethlefsen

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Anterior distal femoral hemiepiphysiodesis (ADFH) is a surgical treatment choice to correct flexed knee gait and fixed knee flexion deformities in children with cerebral palsy who are skeletally immature. Increased anterior pelvic tilt has been reported after surgeries that correct knee flexion deformities, including hamstring lengthening (HSL) and distal femoral extension osteotomies, but anterior pelvic tilt has not been studied after ADFH. We hypothesized that anterior pelvic tilt would increase after ADFH, especially when combined with HSL, and it would correlate with the change in minimum knee flexion in stance and dynamic hamstring lengths. Methods: Thirty-four eligible participants (age: 13.0, SD: 2.0) were included. Change in mean pelvic tilt across the gait cycle was compared as a function of clinical and gait parameters using linear mixed models. The relationship of change in pelvic tilt to change in other variables was examined using Pearson correlation Results: Overall, anterior pelvic tilt increased significantly after ADFH by 4.4 degrees (P = 0.02). Further, the analysis revealed anterior pelvic tilt only increased significantly in the group that had concurrent HSL (11.1 degrees, P < 0.001). Overall, minimum knee flexion significantly decreased (increase in knee extension) in stance (−19.1 degrees, P < 0.001) and there was an increase in maximum normalized dynamic hamstring lengths (0.03, P < 0.001). The anterior pelvic tilt increased significantly in Gross Motor Function Classification System levels III to IV (5.9 degrees, P = 0.02) but did not change significantly in Gross Motor Function Classification System I to II (2.5 degrees, P = 0.37). Change in pelvic tilt was correlated with change in maximum dynamic hamstring lengths (r = 0.87, P < 0.0001) and change in minimum knee flexion in stance (r = −0.71, P < 0.0001). Conclusions: Anterior distal hemiepiphysiodesis without concurrent HSL for flexion knee deformities does not result in increased anterior pelvic tilt. Surgeons should consider anterior distal hemiepiphysiodesis in patients with cerebral palsy and flexed knee gait, who preoperatively have long dynamically modeled hamstrings, are skeletally immature, and when maintenance of pelvic tilt is desired. Level of Evidence: Level III—retrospective comparative study.

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confidence: 99%

mentioning

confidence: 99%

Anterior Distal Femoral Hemiepiphysiodesis Does Not Change Pelvic Tilt in Children With Cerebral Palsy

Hanson,

Wren,

Rethlefsen

et al. 2023

Journal of Pediatric Orthopaedics

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Healthcare Professionals' Perspectives on the Use of Standing Frames for Children Diagnosed With Cerebral Palsy: An Explanatory Mixed Methods Study

Andersen,

Krarup,

Rolving

et al. 2024

Child

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BackgroundStanding frames are commonly used by healthcare professionals in their practice with children with cerebral palsy (CP) who do not have an independent standing function. A better understanding of healthcare professionals' attitudes and experiences with standing frames may impact practice and rehabilitation. Therefore, this study aimed to investigate the standing frame practice among healthcare professionals and expand their attitude and experience with the use of standing frames for children with CP.MethodsThis is an explanatory sequential mixed methods study. A cross‐sectional survey was conducted, providing quantitative data on 210 healthcare professionals' use of standing frames. The quantitative data were descriptively analysed. Subsequently, the results from the survey were followed up with five focus group interviews of healthcare professionals (n = 14). The qualitative data were analysed using thematic analysis, enabling integration between the quantitative and qualitative data.ResultsWhen quantitative and qualitative data are integrated, expansion between the two datasets occurred. The quantitative dataset emphasised the use of GMFCS levels as a guideline for recommending standing frames, whereas the qualitative data showed that the healthcare professionals' recommendations were based on individual needs. Furthermore, the healthcare professionals expanded the quantitative data, showing that the healthcare professionals' considerations regarding age and dosage were based on clinical experience, and saw the standing frame as having many benefits.ConclusionThe healthcare professionals had a child‐centred approach, where the child's need for using a standing frame was assessed based on the functional level, stage of development, cognitive level and clinical assessment. All of these considerations showed that the use of standing frames for children with CP was individualised, thereby making it difficult to make unified descriptions.

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Retrograde Insertion Approach for Anterior Distal Femoral Hemiepiphysiodesis Procedure

Krajewski,

Miller,

Dimovski

et al. 2024

JBJS Case Connector

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Case: A 13-year-old adolescent boy with spastic diplegic cerebral palsy (CP) presented with crouch gait and bilateral knee flexion contractures (KFCs). After failure of conservative treatments, the patient was referred to orthopaedics for surgical intervention. Anterior distal femoral hemiepiphysiodesis (ADFH), using a retrograde approach, and Strayer gastrocnemius recession were performed bilaterally. No complications were reported during surgery/follow-up. Full-active knee extension and improved gait were achieved. Conclusion: KFC is prevalent in ambulatory patients with CP, reducing gait function. Retrograde ADFH is an effective surgical intervention to reduce KFC and improve gait, and offers simpler insertion/removal than the traditional antegrade technique.

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Prevalence of knee contractures is high in children with cerebral palsy in Denmark

Cited by 3 publications

References 28 publications

Anterior Distal Femoral Hemiepiphysiodesis Does Not Change Pelvic Tilt in Children With Cerebral Palsy

Anterior Distal Femoral Hemiepiphysiodesis Does Not Change Pelvic Tilt in Children With Cerebral Palsy

Healthcare Professionals' Perspectives on the Use of Standing Frames for Children Diagnosed With Cerebral Palsy: An Explanatory Mixed Methods Study

Retrograde Insertion Approach for Anterior Distal Femoral Hemiepiphysiodesis Procedure

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