Passive and dynamic rotation of the lower limbs in children with diplegic cerebral palsy

Abstract

Rotation characteristics in gait and passive rotation of the lower limbs were evaluated retrospectively in 105 patients with diplegic cerebral palsy (65 males, 40 females; mean age 13y [SD 6y 9mo]; range 4y 4mo-40y 5mo). Of 105 patients, 22 (20.9%) required crutches, sticks, tripods, or a K-walker for their daily ambulation. Twelve (11.5%) patients used a wheelchair or buggy for community distances, e.g. shopping. Significant differences in rotational characteristics were found at the pelvis, hip, knee, and foot between left and right legs. Patients who were more affected on the right (group R, n=33) or the left side (group L, n=39) were re-evaluated. There was also a group of patients who were not asymmetrically affected (group S, n=33). In group L, maximum passive internal rotation was significantly greater on the left side, while no difference between the sides was found in group R. Peak internal rotation in gait was significantly higher on the right side in group R, but did not differ significantly between the sides in group L. Right hindfoot-thigh angle and transmalleolar axis were more external on the right, irrespective of which leg was more affected. These findings may have implications for the early non-operative management of limb posture in infants with diplegia and the surgical management of established lower extremity malrotation.

Internal rotation gait in spastic diplegia—Critical considerations for the femoral derotation osteotomy

“…van der Linden found significant differences in passive and dynamic transverse plane parameters between the more and less affected legs of 105 diplegic patients [3]. However, determination of subgroups was based on the Edinburgh Gait Score and the Gillette Functional Assessment, which also include sagittal and frontal gait patterns.…”

“…Symmetric and asymmetric transverse plane gait deviations are typically accompanied by sagittal and frontal plane deviations in spastic diplegia [1,3]. Internally rotated gait problems include the ''squinting patella sign'' with an internal foot progression angle or compensatory external tibial torsion [4].…”

Do changes in torsional magnetic resonance imaging reflect improvement in gait after femoral derotation osteotomy in patients with cerebral palsy?

“…Patients with this condition often subsequently develop functional and cosmetic gait disturbances [4] which are frequently accompanied by an increase in the internal foot progression angle. Understanding transverse plane gait deviations is difficult as they are typically also associated with frontal and sagittal plane deviations [1,5]. Pelvic retraction is seen as one compensatory mechanism to correct an internal foot progression angle [6].…”

The Influence of the Unaffected Hip on Gait Kinematics in Patients With Hemiplegic Cerebral Palsy

“…Knee progression angle was calculated as the sum of the mean hip rotation in stance phase and the mean pelvic rotation in stance phase as described by Van der Linden et al, 2007. 8 Negative integers indicate internal dynamic hip rotation, internal dynamic knee progression, or dynamic pelvic protraction.…”