Does additional patella tendon shortening influence the effects of multilevel surgery to correct flexed knee gait in cerebral palsy

• Verfasst von: Klotz, Matthias C. M. [VerfasserIn]
• Verfasst von: Krautwurst, Britta [VerfasserIn]
• Verfasst von: Hirsch, Klemens [VerfasserIn]
• Verfasst von: Thielen, Mirjam [VerfasserIn]
• Verfasst von: Maier, Michael Wolfgang [VerfasserIn]
• Verfasst von: Wolf, Sebastian Immanuel [VerfasserIn]
• Verfasst von: Dreher, Thomas [VerfasserIn]
• Titel: Does additional patella tendon shortening influence the effects of multilevel surgery to correct flexed knee gait in cerebral palsy
• Titelzusatz: a randomized controlled trial
• Verf.angabe: M.C.M. Klotz, Britta K. Krautwurst, K. Hirsch, M. Niklasch, M.W. Maier, S.I. Wolf, T. Dreher
• Jahr: 2018
• Jahr des Originals: 2017
• Umfang: 8 S.
• Fussnoten: Available online 5 December 2017 ; Gesehen am 23.10.2018
• Titel Quelle: Enthalten in: Gait & posture
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1993
• Jahr Quelle: 2018
• Band/Heft Quelle: 60(2018), Seite 217-224
• ISSN Quelle: 1879-2219
• DOI: doi:10.1016/j.gaitpost.2017.12.004
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Cerebral palsy
• Sach-SW: Children
• Sach-SW: Flexed knee gait
• Sach-SW: Motion analysis
• Sach-SW: Patellar tendon shortening
• Sach-SW: Randomized controlled trial
• K10plus-PPN: 1582224315

Abstract

Background The aims of this study were to investigate if patellar tendon shortening (PTS) as a part of SEMLS (single event multilevel surgery) is effective for reduction of flexed knee gait in children with cerebral palsy (CP) and, if PTS leads to stiff knee gait. Methods In a randomized controlled study 22 children with flexed knee gait (age: 10.4±2.6years, GMFCS Level I-III) were randomized and allocated to two groups (1: SEMLS+PTS; 2: SEMLS no PTS): SEMLS was performed for correction of flexed knee gait either with or without additional PTS. Before and after surgery (follow up: 12.7±1.6months) kinematics (3-D motion analysis) and clinical parameters were compared. Results Two children were lost to follow up. Maximum knee extension improved significantly in both groups after SEMLS while the patients with additional PTS showed much more correction (SEMLS+PTS: 37.6° to 11.4°, p=0.007; SEMLS no PTS: 35.1° to 21.8°, p=0.016). After surgery peak knee flexion decreased significantly (14.6°, p=0.004) in the “SEMLS+PTS” group while there was no relevant change in the other group. There was a trend of increase in anterior pelvic tilt after surgery in both groups, but no statistical significant difference. After surgery knee flexion contracture (15.9°, p<0.001) and popliteal angle (27.2, p=0.009) measured on clinical examination only decreased significantly in the “SEMLS+PTS” group. Conclusion PTS is effective for correction of flexed knee gait and knee flexion contracture leading to superior stance phase knee extension. However, additional PTS may lead to stiff knee gait and a higher increase of anterior pelvic tilt.