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

Park, Hoon; Park, Byoung Kyu; Park, Kun-Bo; Abdel-Baki, Sharkawy Wagih; Rhee, Isaac; Kim, Chan Woo; Kim, Hyun Woo

doi:10.3390/jcm8091354

Cited by 14 publications

(16 citation statements)

References 47 publications

(104 reference statements)

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“…Age of cases at SDR was found to be highly correlated with the changes of GDI in our retrospective statistical analysis, which was similar to the ndings in previous studies 10,26 . Such results might be attributed to the adaptability of gait training, of which younger cases usually have better plasticity for motor control 27,28 .…”

Section: Discussionsupporting

confidence: 91%

Short-term Gait Parameters Change in Mild Spastic Cerebral Palsy after Selective Dorsal Rhizotomy Guided by Our Newly-Modified Protocol

Jiang¹,

Jiang²,

Yu³

et al. 2021

Preprint

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Background Selective Dorsal Rhizotomy (SDR) guided by our modified protocol can decrease spasticity in certain muscles. This study aimed to investigate gait parameters changes in cerebral palsy (CP) with focal spasticity after SDR in short-term follow-up. Methods CP classified as Gross Motor Function Classification System (GMFCS) level Ⅰ and Ⅱ who underwent SDR were included. Changes of spasticity, gait parameters and gait deviation index (GDI) were retrospectively reviewed. Results This study contained 26 individuals with 44 affected and 8 intact lower limbs (4 monoplegia, 4 hemiplegia and 18 diplegia). Mean age was 5.7 ± 1.9 years-old and follow-up duration was 9.9 ± 6.6 months. After SDR, average spasticity of 108 target muscles decreased from 2.9 ± 0.8 to 1.8 ± 0.6 in Modified Ashworth Scale (MAS). Kinematic curves changed after the surgery in sagittal and transverse plane in affected sides, further investigation showed improvements in ankle and knee. No changes were found in temporal-spatial parameters except decrease in cadence in affected sides. GDI improved significantly in affected limbs. Conclusion In short-term follow up, the new-protocol-guiding SDR can lower focal spasticity, GA showed improvements in kinematic parameters and GDI. Longer follow-up duration is needed to clarify the long-term outcome.

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Section: Discussionsupporting

confidence: 91%

Short-term Gait Parameters Change in Mild Spastic Cerebral Palsy after Selective Dorsal Rhizotomy Guided by Our Newly-Modified Protocol

Jiang¹,

Jiang²,

Yu³

et al. 2021

Preprint

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“…In these cases, the optimum improvement came with surgical procedures for lengthening the hamstrings. In many cases, even after surgery, the results of hamstring lengthening were inconsistent or did not work at all [14]. The incorporation of the torsional spring was able to counter the excessive flexion moments produced [32] by applying the stored energy from knee flexion to provide the necessary knee extension [33].…”

Section: Discussionmentioning

confidence: 99%

“…Inefficiency in gait is well documented [9][10][11][12]. Complications of uncorrected crouch gait result in increasing load on the knee joint [2,13] which likely causes knee pain [5,14,15] and joint deterioration [2,16,17]. The stance phase of the gait cycle is the weightbearing portion of the gait cycle.…”

Section: Introductionmentioning

confidence: 99%

Incorporation of Torsion Springs in a Knee Exoskeleton for Stance Phase Correction of Crouch Gait

et al. 2022

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Crouch gait is a motor complication that is commonly associated with cerebral palsy, spastic diplegia, stroke, and motor-neurological pathologies, broadly defined as knee flexion in excess of 20° in the gait cycle. Uncorrected crouch gait results in fatigue, joint degradation, and loss of ambulation. Torsion springs have been used in cycling to store energy in the knee flexion to reduce fatigue in the quadriceps during knee extension. SolidWorks was used to design a passive exoskeleton for the knee, incorporating torsion springs of stiffnesses 20,000 N/mm and 30,000 N/mm at the knee joint, to correct four different crouch gaits. OpenSim was used to gather data from the moments produced, and knee angles from each crouch gait and the normal gait. Motion analysis of the exoskeleton was simulated using knee angles for each crouch gait and compared with the moments produced with the normal gait moments in the stance phase of the gait cycle. All crouch gait moments were significantly reduced, and the correction of peak crouch moments was achieved, corresponding to the normal gait cycle during the stance phase. These results offer significant potential for nonsurgical and less invasive options for wearable exoskeletons in crouch gait correction.

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“…Extension shortening osteotomy can be performed to lengthen the extensors and flexors and compensate for the flexion contracture [14][15][16]. Based on the treatment of arthrogryposis multiplex congenita and cerebral palsy in multiple joints, soft tissue surgeries are not sufficient to correct fixed contractures; thus, bony procedures are often required.…”

Section: Introductionmentioning

confidence: 99%

One-Stage Extension Shortening Osteotomy for Syndromic Camptodactyly

Park

Kim

Park

et al. 2020

JCM

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Syndromic camptodactyly often affects multiple fingers, and severe deformities are common compared to idiopathic camptodactyly. This study aimed to evaluate the use of a one-stage extension shortening osteotomy of the proximal phalanx for patients with syndromic camptodactyly without tendon surgery. Forty-nine cases of syndromic camptodactyly were included. Forty fingers (81.6%) were associated with arthrogryposis multiplex congenita, and nine (18.4%) with other syndromes. Six fingers presented with a moderate form (30° to 60°) of camptodactyly, whereas 43 fingers manifested the severe form (>60°). The mean age at the time of surgery was 8.5 years, and the patients were followed for a mean of 3.9 years. The mean length of the shortening of the proximal phalanx was 4.9 mm, which averaged 17.8% of the proximal phalanx’s original preoperative length. The mean operative time was 25.8 min, and the PIP joint was fixed using Kirschner wires with an average flexion position of 7.6°. The mean flexion contracture improved from 76° preoperatively to 41° postoperatively. The mean preoperative active arc of motion was 23°, which improved to 49° postoperatively. A one-stage extension shortening osteotomy is a straightforward and effective technique for the improvement of finger function through the indirect lengthening of volar structures without the flexor tendon lengthening. The osteotomy could simultaneously correct bony abnormalities. This simple procedure is especially suitable for surgery on multiple fingers in patients with syndromic camptodactyly.

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

Cited by 14 publications

References 47 publications

Short-term Gait Parameters Change in Mild Spastic Cerebral Palsy after Selective Dorsal Rhizotomy Guided by Our Newly-Modified Protocol

Short-term Gait Parameters Change in Mild Spastic Cerebral Palsy after Selective Dorsal Rhizotomy Guided by Our Newly-Modified Protocol

Incorporation of Torsion Springs in a Knee Exoskeleton for Stance Phase Correction of Crouch Gait

One-Stage Extension Shortening Osteotomy for Syndromic Camptodactyly

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