Changes in Pelvic Rotation After Soft Tissue and Bony Surgery in Ambulatory Children With Cerebral Palsy

Kay, Robert M.; Rethlefsen, Susan A.; Reed, Marty; Patrick, K.; Skaggs, David L.; Wren, Tishya A. L.

doi:10.1097/00004694-200405000-00008

Cited by 17 publications

(33 citation statements)

References 2 publications

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“…In our study, the effect of soft tissue surgery on internal hip rotation tended to increase somewhat with increasing preoperative rotation. However, the differences were not statistically significant, indicating no reliable effect, which is in keeping with the work of Kay et al (2004). These results seem to be in sharp contrast to those of Steinwender et al (2000), who reported a marked improvement of no less than 12° after soft tissue surgery and attributed this positive effect to hamstring lengthening.…”

Section: Discussionsupporting

confidence: 64%

“…Kay et al (2004) reported a mean decrease in internal foot progression of 5° but did not mention whether the decrease was larger in limbs with abnormally high preoperative foot progression. We found that the difference between pre-and postoperative foot progression increased with increasing preoperative values.…”

Section: Discussionmentioning

confidence: 99%

“…Kay et al (2004) reported a mean decrease of 3° in pelvic retraction after soft tissue surgery. Steinwender et al (2000) found no effect on pelvic rotation, but they included the pelvis on both sides, which is hardly adequate because external rotation of one hemipelvis cancels internal rotation of the other side.…”

Section: Discussionmentioning

confidence: 99%

“…Steinwender et al (2000) found no effect on pelvic rotation, but they included the pelvis on both sides, which is hardly adequate because external rotation of one hemipelvis cancels internal rotation of the other side. In accordance with Kay et al (2004), we included only the side with more external pelvic rotation. We found no effect on pelvic retraction in children with preoperative external rotation within the normal range, whereas children with preoperative retraction more than mean + 2 SD of the control group had a mean improvement of 7° after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few studies have assessed the results of soft tissue surgery. Moreover, previous studies of the effect on hip rotation and pelvic rotation have found divergent results (Steinwender et al 2000, Kay et al 2004, Lovejoy et al 2007). …”

Section: Introductionmentioning

confidence: 95%

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Changes in lower limb rotation after soft tissue surgery in spastic diplegia

Lofterød

Terjesen

2010

Acta Orthopaedica

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Background and purpose Rotational osteotomies are usually necessary to correct pronounced rotational deformities in ambulant children with cerebral palsy. The effects of soft tissue surgery on such deformities are unclear. In this retrospective study, we determined whether multilevel soft tissue surgery, performed to correct deformities in the sagittal plane, would also have an effect on rotational parameters.Patients and methods We examined 28 ambulant children with spastic diplegia with an average age of 12 (7–19) years. They underwent multilevel soft tissue surgery (with 6 surgical procedures per child on average). 3-dimensional gait analysis was performed preoperatively and at an average follow-up of 1–2 years. The indications for surgery were abnormalities in the sagittal plane. Gait analysis data from healthy children were used in defining normal ranges of kinematic variables. For assessment of changes in the transverse plane, the angles of foot progression, hip rotation, and pelvic rotation were studied.Results The transverse plane kinematic results showed no statistically significant postoperative changes when the preoperative parameters were within the normal range (within 2 SD of the mean of the normal material). In limbs where the preoperative values were abnormal (more than 2 SD above the normal mean), there was a mean reduction in internal foot progression of 12° (p = 0.01) and a mean reduction in external pelvic rotation of 6° (p = 0.02). The effect was more pronounced in children under 12 years of age. Internal hip rotation was not significantly reduced.Interpretation When the preoperative rotational parameters were abnormal, multilevel soft tissue surgery resulted in improved transverse plane kinematics. This could be of importance in preoperative decision making, especially when there is doubt as to whether to include rotational osteotomies in multilevel operations in younger children.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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