Leg lengthening as part of gait improvement surgery in cerebral palsy: an evaluation using gait analysis

Area of Science:

• Orthopedic Surgery
• Pediatric Neurology
• Biomechanical Engineering

Background:

• Cerebral palsy (CP) often presents with gait abnormalities, including leg length discrepancies (LLD).
• Significant LLD (>2.5 cm) in children with hemiplegic or asymmetric diplegic CP can negatively impact gait biomechanics.
• Preoperative gait analysis reveals compensatory patterns in the unaffected limb, such as excessive hip/knee flexion and ankle dorsiflexion.

Purpose of the Study:

• To evaluate the effectiveness of gait improvement surgery, including leg length equalization, in children with CP and LLD.
• To assess changes in sagittal plane kinematics and kinetics of both limbs after surgery.
• To determine if surgical leg length equalization can normalize gait patterns in the unaffected limb.

Main Methods:

• Study included eleven children with hemiplegic or asymmetric diplegic CP and preoperative LLD > 2.5 cm.
• Surgical intervention involved leg length equalization.
• Sagittal plane kinematics and kinetics were analyzed preoperatively and approximately 3 years post-surgery for both limbs.

Main Results:

• Preoperative analysis showed excessive stance phase hip and knee flexion, and ankle dorsiflexion in the unaffected limb.
• Approximately 3 years after leg length equalization surgery, these abnormal kinematic patterns were partially reversed.
• The gait pattern of the previously unaffected limb became comparable to age-matched normal controls.

Conclusions:

• Leg length equalization surgery is an effective intervention for improving gait in children with CP and significant LLD.
• The procedure can normalize kinematic deviations in the unaffected limb, leading to a more symmetrical and typical gait pattern.
• This surgical approach offers a viable strategy for enhancing mobility and functional outcomes in pediatric CP patients with LLD.