The effect of distal femoral extension osteotomy on muscle lengths after surgery

Lenhart, Rachel L.; Cr, Smith; Schwartz, Michael H.; Novacheck, Tom F.; Thelen, Darryl G.

doi:10.1302/1863-2548.11.170087

Cited by 11 publications

(12 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It has been noted that there is a potential risk for the development of a stiff knee gait due to quadriceps tightness from a PTA [14,19,43,44]. A study using generic musculoskeletal modelling postulated that the quadriceps undergoes substantial shortening with DFEO, and that this can be compensated by performing a simultaneous PTA [24]. Contrary to our belief that DFSO has more of a tension-relieving effect on the quadriceps than DFEO, the degrees of maximum knee flexion in swing phase decreased and the timing of peak knee flexion was delayed.…”

Section: Discussionmentioning

confidence: 99%

“…However, simple femoral extension osteotomy can lead to several problems in patients with severe knee flexion contracture. Posterior bony prominences can develop after correction of the deformity and may cause neurovascular compromise, whilst the resultant hamstrings stretch may further increase the risk of postoperative nerve palsy [15,23,24]. Moreover, there is a possibility that the hyperextension, created at the osteotomy site, may cause tibio-femoral joint incongruity and eccentric articular cartilage damage over time (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy

Park

et al. 2019

JCM

View full text Add to dashboard Cite

Although there have been advancements of surgical techniques to correct gait abnormalities seen in patients with cerebral palsy, the crouch gait remains one of the most difficult problems to treat. The purpose of this retrospective study was to examine our results of distal femoral shortening osteotomy (DFSO) and patellar tendon advancement (PTA), performed in patients with crouch gait associated with severe knee flexion contracture. A total of 33 patients with a mean fixed knee contracture of 38° were included in the study. The mean age at the time of surgery was 12.2 years and the mean follow-up was 26.9 months. The measurements of clinical, radiological, and gait parameters were performed before and after surgery. The mean degrees of knee flexion contracture, Koshino index of patella height, and Gait Deviation Index were found to be significantly improved at the time of final follow-up. The maximum knee extension during the stance phase improved by an average of 25°, and the range of knee motion during gait increased postoperatively. On the other hand, the mean anterior pelvic tilt increased by 9.9°. Also, the maximum knee flexion during the swing phase decreased and the timing of peak knee flexion was observed to be delayed. We conclude that combined procedure of DFSO and PTA is an effective and safe surgical method for treating severe knee flexion contracture and crouch gait. However, the surgeons should be aware of the development of increased anterior pelvic tilt and stiff knee gait after the index operation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy

Park

et al. 2019

JCM

View full text Add to dashboard Cite

show abstract

“…In an Extension and Derotation Osteotomy (Figure 2B), two cutting planes define the bone wedge for removal (Lenhart et al, 2017). In the GUI, the pose of the cutting planes on the desired bone can be defined.…”

Section: Methodsmentioning

confidence: 99%

SimCP: A Simulation Platform to Predict Gait Performance Following Orthopedic Intervention in Children With Cerebral Palsy

et al. 2019

View full text Add to dashboard Cite

Gait deficits in cerebral palsy (CP) are often treated with a single-event multi-level surgery (SEMLS). Selecting the treatment options (combination of bony and soft tissue corrections) for a specific patient is a complex endeavor and very often treatment outcome is not satisfying. A deterioration in 22.8% of the parameters describing gait performance has been reported and there is need for additional surgery in 11% of the patients. Computational simulations based on musculoskeletal models that allow clinicians to test the effects of different treatment options before surgery have the potential to drastically improve treatment outcome. However, to date, no such simulation and modeling method is available. Two important challenges are the development of methods to include patient-specific neuromechanical impairments into the models and to simulate the effect of different surgical procedures on post-operative gait performance. Therefore, we developed the SimCP framework that allows the evaluation of the effect of different simulated surgeries on gait performance of a specific patient and includes a graphical user interface (GUI) that enables performing virtual surgery on the models. We demonstrated the potential of our framework for two case studies. Models reflecting the patient-specific musculoskeletal geometry and muscle properties are generated based solely on data collected before the treatment. The patient's motor control is described based on muscle synergies derived from pre-operative EMG. The GUI is then used to modify the musculoskeletal properties according to the surgical plan. Since SEMLS does not affect motor control, the same motor control model is used to define gait performance pre- and post-operative. We use the capability gap (CG), i.e., the difference between the joint moments needed to perform healthy walking and the joint moments the personalized model can generate, to quantify gait performance. In both cases, the CG was smaller post- then pre-operative and this was in accordance with the measured change in gait kinematics after treatment.

show abstract

“…Osteotominin yeri ve miktarına bağlı olarak hem femurda hem de adale çalışma mesafelerinde kısalmalar, sinir hasarları ortaya çıkabilir. [30]…”

Section: Anti Rekurvatum Osteotomileriunclassified

Diz çevresi osteotomilerinin biyomekanik prensipleri

Bombacı¹

2020

TOTBID

View full text Add to dashboard Cite

Türk Ortopedi ve Travmatoloji Birliği Derneği deformitenin yönüne, miktarına, sebebine ve OA'nın etkilediği bölgeye göre tibia proksimal veya femur distal varus/valgus osteotomisi ya da her iki bölgeye beraber uygulanan kombine osteotomiler şeklinde uygulanabilir. Ancak bu osteotomiler uygulanırken osteotomi yapılacak diz bölgesindeki bağların durumları ve karşı ekstremite de hesaba katılmalıdır. Özellikle kronik instabilitelerde primer ( primary), sekonder ( secondary) ve tersiyer (triple) varus diz olarak da adlandırılan deformitelerde, diz çevresindeki bağ ve yumuşak doku değişikliklerinin deformite planlamasında göz önünde D iz çevresi osteotomileri dizdeki tek kompartman artrozlarının tedavisinde çok yaygın kullanılmaktadır. [1,2] Deformitenin kaynağı eklem dışı ise osteotomi "düzeltici osteotomi" olarak kabul edilirken, eklem içi deformitelerde yapılan osteotomilere yük dağılımını başka bir deformite oluşturarak dengelediği için "palyatif osteotomi"ler denir. Bu tekniklerle özellikle erken dönem osteoartrozda (OA) ve genç hastalarda çok daha iyi sonuçlar alınmaktadır. Çoğunlukla varus dizlerde proksimal tibial açık kama osteotomisi (AKO) şeklinde uygulanan osteotomiler, Diz çevresi osteotomilerinin biyomekanik prensipleriBiomechanical principles of osteotomies around the knee

show abstract

The effect of distal femoral extension osteotomy on muscle lengths after surgery

Cited by 11 publications

References 37 publications

Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy

Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy

SimCP: A Simulation Platform to Predict Gait Performance Following Orthopedic Intervention in Children With Cerebral Palsy

Diz çevresi osteotomilerinin biyomekanik prensipleri

Contact Info

Product

Resources

About