The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy

Abstract

Background Indications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP). Methods Inclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11°; group 2: greater than or equal to 11°), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively. Results Sixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months. Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively. Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001. There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D. Conclusions Relative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.

Aberrant movement‐related somatosensory cortical activity mediates the extent of the mobility impairments in persons with cerebral palsy

“…reduced step length), reduced metabolic efficiency, and deficient ankle power production (Abel & Damiano, 1996; Barber et al., 2017; Kurz, Arpin et al., 2012; Unnithan et al., 1996). Historically, the identification of the possible cause of an individual's gait impairments have centred on the musculoskeletal system, where it has been shown that many persons with CP often present bony torsional abnormalities, musculoskeletal contractures, muscular weakness, and alterations in the musculotendon architecture (Hanssen et al., 2021; Hegarty et al., 2020; Moreau et al., 2012; Pantzar‐Castilla et al., 2021). More recently, there has been a growing body of literature linking such gait impairments to alterations in the somatosensory and primary motor cortical activity that governs leg motor actions (George et al., 2021; Kurz, Wilson et al., 2014; Kurz, Heinrichs‐Graham et al., 2015; Kurz et al., 2020; Short et al., 2020).…”