Residual Deformity and Outcome of Ambulatory Adults With Cerebral Palsy: A Long-term Longitudinal Assessment

Abstract

Background: Advances in pediatric orthopaedic care have improved mobility and function for children with cerebral palsy (CP) as mobility declines from adolescence into adulthood. The long-term effectiveness of modern orthopaedic care is not widely reported. This study aimed to report the pediatric orthopaedic surgical burden, residual deformities, and outcomes using objective evidence of mobility in ambulatory adults with CP. Methods: An institutional review board–approved prospective cohort study was performed in ambulatory adults with CP between 25 and 45 years, who had an adolescent gait analysis. Orthopaedic interventions were reviewed, and adolescent and adult gait analyses were compared using paired 2-tailed t tests. Adults were categorized by the presence of no, mild, or severe residual deformities in rotation, crouch, stiff knee, equinus, and foot deformity. Results: Of 106 adults with CP, Gross Motor Function Classification System (GMFCS) distribution was grade I (22%), II (50%), III (23%), and IV (5%). Sixty-one males and 45 females were tested. The average age was 30±4 years with follow-up of 13±4 years since previous analysis; 279 surgical events (1165 procedures) were performed with a mean per patient of 2.6 events and 11 procedures. Comm on procedures were gastrocsoleus complex (88%) and hamstring lengthening (79%). The mean gait deviation index at adolescent and adult visit were 72.7±13 and 72.3±13 (P=0.78). Mean gait velocity at the adolescent visit was 85±27 and 79±31 cm/s at adult visit (P=0.02). Both gait deviation index and gait velocity change were clinically insignificant. Fifty-seven adults (81 limbs, 54%) had mild residual deformities. Residual hip internal rotation, pes planovalgus, and crouch gait were common. Severe deformities impacting function or causing pain were present in 11 participants (14 limbs, 10%). Seven of the 11 adults with severe deformities were worse compared with their adolescent evaluation; 4 were unchanged. Conclusions: Correcting deformities before adulthood has lasting stability with little functional loss in most ambulatory young adults with CP. Increasing deformity after adolescence can occur in young adults but is uncommon. Level of Evidence: Level III.

A 10.5-year follow-up of walking with unilateral spastic cerebral palsy

“…drop foot, equinus, in-toeing or out-toeing gait). 19,37 These results accord with Schranz et al’s, 20 which showed significant improvements in GPS after a 10-year follow-up of 14 patients with USCP who underwent SEMLS. They also found that GVS were significantly better for foot progression angle, ankle, knee, and hip flexion–extension angles, and (contrary to the present study) pelvis rotation.…”

“…11 These scores are relevant indicators of overall gait pathology (expressed in degrees) for assessing pathological gait characteristics and detecting changes, such as before and after treatment. 12 Several studies in the literature have observed the longterm gait evolution of children with CP, mostly focusing on patients with bilateral CP [13][14][15][16][17][18][19] and showing improved gait scores thanks to surgery. However, to the best of our knowledge, few published articles have examined the long-term gait evolution of USCP patients.…”

“…Several studies in the literature have observed the long-term gait evolution of children with CP, mostly focusing on patients with bilateral CP 13–19 and showing improved gait scores thanks to surgery. However, to the best of our knowledge, few published articles have examined the long-term gait evolution of USCP patients.…”

What’s New in Pediatric Orthopaedics

“…A review of adults with cerebral palsy who had undergone orthopaedic procedures as adolescents found that residual hip internal rotation, pes planovalgus, and crouch gait were common, but 90% did not have any severe deformities impacting function or causing pain 52 .…”

Symptomatic flatfoot in cerebral palsy

“…In particular, pes planovalgus is most common in children with bilateral involvement, as with diplegia or quadriplegia [3,4]. This deformity becomes more prevalent with age and can even present in adulthood [5 ▪▪ ]…”