Discrimination of Abnormal Gait Parameters Due to Increased Femoral Anteversion from other Effects in Cerebral Palsy

Abstract

The effects of increased femoral anteversion (IFA) on gait pattern have a complex relationship with other orthopaedic and neurological abnormalities of cerebral palsy (CP). The aim of this study was to differentiate the effects of IFA from other factors in CP. The four groups in this study included: 15 typically developing children (Group: TDC) (age: 9.7 ± 0.5); 14 TDC with IFA (7.5 ± 1.7) (Group: TDC-IFA); 8 CP participants with IFA (age: 6.3 ± 1.7) (Group: CP IFA); and 10 CP participants with nearly normal femoral anteversion (age: 10.3 ± 4.7) (Group: CP-NFA). Altered peak knee-extension angle and stance-time, increased internal hip-rotation, internal foot-progression (p≤0.05) were influenced by IFA in both groups of CP-NFA and TDC-IFA. For the TDC groups; pelvic-rotation increased and peak knee and hip-extension, knee flexion-moment, peak knee-power generation in late-stance decreased among children with IFA (p≤0.05). For CP children; anterior pelvic-tilt, hip-flexion and peak knee-extension, hip power-absorbsion and generation, and peak knee power-absorsion (K3) increased and peak knee-flexion was delayed by IFA (p≤0.05). Therefore, IFA effects are different in CP and TDC. Peak knee-extension angle increased in TDC and decreased in CP with IFA. Besides the well known gait parameters related to IFA which are increased internal hip-rotation and foot-progression angle, it is recognised that peak knee-extension and stance-time are also influenced. Therefore, before muscle lengthening, femoral derotational osteotomy should be considered in the early stages of growth in CP to improve pelvic stability and the knee extensor mechanism.

Relation of Hip Anteversion, Knee Flexion Angle and Balance in Spastic Diplegic Cerebral Palsied Children

“…Increased FA refers to a structural deformity that could affect the adjustment of foot progression angle [8], and recent studies have reported that it is a cause of gait abnormalities and lower extremity deformities [9]. Biomechanically, increased FA is thought to place the hip abductor muscles at a biomechanical disadvantage during ambulation by decreasing the functional lever arm relative to the hip joint center during the stance phase [10].…”

“…Even though there have been several studies focused on the importance of postural control and balance in children with CP, the relationship between FA angle, knee angle and balance is still a question. It was reported that the effect of IFA on gait pattern have a complex relationship with other orthopedic and neurological abnormalities of cerebral palsy [9]. Gait pattern of spastic diplegic CP had been studied by Lin et al, who showed that gait is altered based on the characteristics of the knee joint [13].…”

Role of femoral derotation on gait after selective dorsal rhizotomy in children with spastic cerebral palsy

“…12 Such femoral malrotation can lead to an internally rotated gait and increased anterior pelvic tilt; it also causes bony lever arm dysfunction, commonly resulting in a reduction of the internal hip abduction moment. [13][14][15] External tibial torsion can further interfere with the child's ambulation by reducing the knee extension moment. Femoral and/or tibial derotation osteotomies can improve gait by correcting the bony lever arms.…”

Femoral derotation osteotomy with multi-level soft tissue procedures in children with cerebral palsy: Does it improve gait quality?

“…Gait analysis also provides further information about pelvic rotation in the transverse plane, and this information can help the surgeon to interpret transverse plane abnormalities [ 11 ]. Akalan et al studied the gait parameters of CP children with increased FA and compared these with those of children with increased FA who were developing normally [ 34 ]. These authors noted that the effects of increased FA differ between a child with CP and a normal child.…”