Treatment approaches to flexion contractures of the knee

Abstract

The knee is the most affected joint in children with cerebral palsy. Flexion contracture of the knee is the cause of crouch gait pattern, instability in stance phase of gait, and difficulties during standing and sitting, and for daily living activities. It may also cause patella alta, degeneration of the patellofemoral joint, and stress fractures of the patella and tibial tubercle in young adults. Children with cerebral palsy may even give up walking due to its high energy demand in the adult period. The purpose of this article is to review the causes of the knee flexion contractures, clinical and radiological evaluations, and treatment principles in children with cerebral palsy. The biomechanical reasons of knee flexion deformity are discussed in detail in the light of previous studies and gait analysis data.

Electromyographic analysis of rectus femoris activity during seated to standing position and walking in water and on dry land in healthy children and children with cerebral palsy

“…We hypothesized that this difference may have been caused by the ''crouch knee'' gait pattern, which is characteristic of the spastic diparesis type of CP and involves greater flexion of the knees during the support phase and an increase in the knee extensor moment. Greater flexion of the knees and increased knee extensor movement leads to a p=0.0683 p=0.9102 p=0.0014 greater activity of the rectus femoris while attempting to extend the knee (Temelli and Akalan, 2009), which explains the increase in the activity of the rectus femoris while walking on dry land. The children with CP also exhibited greater activity of the rectus femoris muscle while walking in the liquid medium compared with the control group (p = 0.007).…”

Operative Treatment of the Knee Contractures in Cerebral Palsy Patients

“…Based on the experience gained from performing gait analysis on more than 588 patients with cerebral palsy, four primary gait abnormalities of the knee have been identified: jump knee, crouch knee, stiff knee, and recurvatum knee (6). The treatment options of patients with spastic cerebral palsy range from conservative to surgical treatments depending on the severity of the condition (7, 8). Analyses have been made to understand the relationship between the joint contractures in cerebral palsy patients and their effect on stance and gait (9).…”

Patella fractures in children

“…Bunun nedeni spastik serebral palside dizin tam ekstansiyona getirilememesi ve patellaya tekrarlayıcı yük binmesidir. [13,14] Bu kırıkların tedavisinde bugüne kadar hamstring uzatılması uygulana gelmiştir. [15] Ancak sağlıklı çocuklarda tek tük de olsa patella stres kırığı tanımlanmış ve konservatif tedavi edilmiştir.…”