Does additional patella tendon shortening influence the effects of multilevel surgery to correct flexed knee gait in cerebral palsy: A randomized controlled trial.

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 ± 2.6 years, 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 ± 1.6 months) 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.

journal_name

Gait Posture

journal_title

Gait & posture

authors

Klotz MCM,Krautwurst BK,Hirsch K,Niklasch M,Maier MW,Wolf SI,Dreher T

doi

10.1016/j.gaitpost.2017.12.004

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

217-224

eissn

0966-6362

issn

1879-2219

pii

S0966-6362(17)31028-7

journal_volume

60

pub_type

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