Flexed-knee gait in children with cerebral palsy: A 10-year follow-up study

Haumont, T.; Church, Chris; Hager, Shaun; Cornes, Maria Julia; Poljak, Dijana; Lennon, Nancy; Henley, John; Taylor, Daveda; Niiler, Tim; Miller, Freeman

doi:10.1007/s11832-013-0505-8

Cited by 28 publications

(10 citation statements)

References 30 publications

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“…In our study, DHL, as part of a SEMLS, was effective for the treatment of flexed knee gait and the parameters of 3D gait analysis after surgery were similar to those in previous studies (Table 5 ). Many authors have reported short-term favorable outcomes in terms of sagittal knee joint parameters after DHL [ 2 , 4 – 8 , 17 ], and recent studies investigating the long-term outcomes of DHL showed that these improvements were maintained at over 10 years postoperatively [ 11 , 13 , 14 , 18 ]. The present study also found that the improvement in knee flexion at initial contact, minimum knee flexion in the stance phase, and knee ROM after DHL was maintained during the follow-up duration in patients with GMFCS level I and II, although there was concern that the favorable surgical outcomes might diminished over time.…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been concerns that DHL might aggravate anterior pelvic tilt, lumbar hyperlordosis, and genu recurvatum, and eventually induce crouch gait [ 2 , 17 ]. Even though the length of time of improvement in knee motion are maintained is unclear, several studies showed that the improvements after DHL were maintained 10 years postoperatively in patients with CP [ 11 , 13 , 14 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing outcomes after medial hamstring lengthening with semitendinosus transfer in patients with cerebral palsy

Sung

Lee

Chung

et al. 2017

J NeuroEngineering Rehabil

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BackgroundAlthough several studies have investigated the outcomes after distal hamstring lengthening (DHL), no study has undertaken an approach that included all or most of the important factors that could influence the results. This study was performed to evaluate the outcomes after DHL and analyze the factors that influence the improvement and serial change in knee motion after surgery in patients with cerebral palsy (CP), using a linear mixed model (LMM).MethodsThe study included 314 ambulatory CP patients (594 limbs) with spsastic diplegia who were followed up after undergoing DHL as part of a single-event multilevel surgery and who underwent preoperative and postoperative 3-dimensional (3D) gait analyses. Relevant kinematic values, including knee flexion at initial contact, minimum knee flexion in the stance phase, knee range of motion (ROM), mean pelvic tilt and gait deviation index (GDI) score, were the outcome measures. Changes in knee motion and the GDI score were adjusted for multiple factors, such as sex, the Gross Motor Function Classification System (GMFCS) level, and concomitant surgeries as fixed effects, and follow-up duration, laterality, and each subject as random effects, using a LMM.ResultsWe found significant improvements in knee flexion at initial contact, minimum knee flexion in the stance phase, knee ROM, and GDI score 2 years after DHL. In patients with GMFCS level I and II, improvement in all sagittal knee kinematics was maintained during follow-up. In addition, GDI score, which represents overall gait pathology, consistently improved throughout the follow-up duration (1.2 per year, p = 0.008).ConclusionMedial hamstring lengthening with semitendinosus transfer, as a part of a SEMLS, was effective procedure in treating flexed knee gait with regard to sagittal knee kinematics and GDI score in spastic CP with flexed knee gait.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors influencing outcomes after medial hamstring lengthening with semitendinosus transfer in patients with cerebral palsy

Sung

Lee

Chung

et al. 2017

J NeuroEngineering Rehabil

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“…Regardless of the treatment plan that is implemented, motion analysis can assess the outcome of the interventions (Table ) . Postoperative motion analysis is usually conducted one year after the surgery.…”

Section: Interdisciplinary Treatment Planningmentioning

confidence: 99%

Single‐Event Multilevel Surgery to Correct Movement Disorders in Children with Cerebral Palsy

Wick¹,

Feng²,

Raney³

et al. 2018

AORN Journal

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Cerebral palsy (CP) is a common motor disability that may be congenital or acquired. Children with CP often have gait, balance, and posture abnormalities, some of which may be severe enough to interfere with safe ambulation or other activities of daily living. Nonsurgical and surgical interventions are part of the management plan for children with CP. Historically, surgeons addressed gait deviations individually and sequentially with single‐level surgeries. However, computerized motion analysis and advances in orthopedic internal fixation devices have improved the outcomes for patients undergoing single‐event multilevel surgery. This article provides perioperative RNs with a basic understanding of movement disorders that can be corrected with single‐event multilevel surgery, the role of computerized motion analysis in making treatment decisions for ambulatory pediatric orthopedic patients with CP, and various treatment options for the movement disorders of children with CP.

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“…Other authors defined KFGP by a knee flexion at initial contact superior to15° [5] or 17° [6] corresponding to one standard deviation (SD) above the mean flexion at initial contact for a typically developing children.…”

Section: Introductionmentioning

confidence: 99%

Kinematics can help to discriminate the implication of iliopsoas, hamstring and gastrocnemius contractures to a knee flexion gait pattern

Attias

Bonnefoy‐Mazure²,

Coulon³

et al. 2019

Gait & Posture

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Background: Excessive Knee Flexion Gait Pattern (KFGP) is a common gait deviation in many pathological conditions. The contractures of the muscles that have been identified as being responsible of KFGP are: iliopsoas, hamstring and gastrocnemius. Research question:How do isolated contractures of the iliopsoas, hamstrings and gastrocnemius impact knee flexion during gait?Methods: Three levels of contracture (mild, moderate and severe) were simulated bilaterally using an exoskeleton on 10 healthy participants for iliopsoas, hamstring and gastrocnemius muscles. A gait analysis session was performed to evaluate the joint kinematics according to the different simulated contractures. Thirty one parameters were chosen to analyze the kinematics of the thorax, pelvis, hip, knee and ankle. A principal component analysis (PCA) was used to determine the kinematic parameters influenced by contractures. Results:In addition to a permanent knee flexion observed for the three muscles with contracture: the contracture of the iliopsoas induces a large hip flexion with pronounced anterior pelvis tilt; the contracture of the hamstrings induces an ankle dorsiflexion during the support phase with a posterior pelvis tilt; the contracture of the gastrocnemius induces an absence of first and second rocker of the ankle with a slight flexion of hip and a slight anterior pelvis tilt.Significance: These results support the identification of the muscles responsible for a KFGP.A better knowledge of the interactions between contractures and associated joint kinematics of the same and adjacent joints will support the interpretation of gait analyses by more precisely and faster targeting the concerned muscle.

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Flexed-knee gait in children with cerebral palsy: A 10-year follow-up study

Cited by 28 publications

References 30 publications

Factors influencing outcomes after medial hamstring lengthening with semitendinosus transfer in patients with cerebral palsy

Factors influencing outcomes after medial hamstring lengthening with semitendinosus transfer in patients with cerebral palsy

Single‐Event Multilevel Surgery to Correct Movement Disorders in Children with Cerebral Palsy

Kinematics can help to discriminate the implication of iliopsoas, hamstring and gastrocnemius contractures to a knee flexion gait pattern

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