Anterior knee pain in children with cerebral palsy

Anterior knee pain arising from the patellofemoral joint may be a significant problem in the cerebral palsy (CP) population. The aim of this study was to classify patients with anterior knee pain based on etiology and organize orthopaedic management based on this classification. This study was a retrospective chart review of patients with CP and anterior knee pain admitted to the orthopaedic outpatient clinic between 1991 and 2003. Children with CP who had intractable anterior knee pain despite 6 months of conservative treatment with at least 2 years' follow-up were identified and included. The medical records, radiographs, and treatment protocols were screened. Patients were classified into 3 groups according to pathology. Group I consisted of 7 children with patella alta only. Group II consisted of 7 children with patellar inferior pole fractures. Group III consisted of 13 children with subluxated or dislocated patellas. Conservative treatment methods such as anti-inflammatory drugs, local ice packs, stretching exercises, and braces should be the first step in treatment. For those patients in whom conservative treatment was not effective, surgical treatment alternatives were discussed. Knee pain resolved in all patients after surgical treatment of the underlying pathology. Gait analysis can be performed for patients with patellofemoral subluxations to evaluate the rotational malalignment of the tibia and femur. In conclusion, anterior knee pain arising from the patellofemoral joint in patients with CP should be evaluated and treated to prevent future functional deterioration.