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Natural history of knee contractures in myelomeningocele
J G Wright1, M B Menelaus, N S Broughton
1Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut.
Insights
Knee contracture in myelomeningocele (MM) patients initially improves but worsens with age, especially in higher MM levels. Muscle imbalance and spasticity appear to have minimal impact on this progression.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Developmental Pediatrics
Background:
- Myelomeningocele (MM) is a complex congenital condition affecting spinal cord development.
- Knee contractures are a common complication in MM patients, impacting mobility and function.
- Understanding the natural history of knee contracture is crucial for effective management.
Purpose of the Study:
- To prospectively investigate the natural history of knee contracture in a large cohort of myelomeningocele patients.
- To identify factors influencing the development and progression of knee contracture.
- To assess the role of muscle imbalance and spasticity in MM-related knee contractures.
Main Methods:
- Prospective study of 850 myelomeningocele patients aged neonate to 23 years.
- Exclusion of patients who underwent knee surgery.
- Longitudinal assessment of knee flexion contracture and range of motion.
Main Results:
- Knee contracture initially decreased by 9 months but increased after this age in patients with MM levels above L3.
- Patients with thoracic/L1-L3 MM levels showed mean fixed flexion contracture of 18 degrees (with spasticity) and 17 degrees (without spasticity).
- Knee range of motion decreased after age 3 years in patients with MM levels above L3.
Conclusions:
- Knee contracture in myelomeningocele patients follows a complex natural history influenced by the level of the spinal defect.
- Muscle imbalance and spasticity appear to play a minimal role in the development of knee contracture in this population.
- Further research is needed to elucidate the primary drivers of knee contracture progression in myelomeningocele.
Abstract:
The natural history of knee contracture was determined in a prospective study of 850 myelomeningocele (MM) patients, ranging in age from neonate to 23 years, excluding patients after knee surgery. Fixed flexion contracture of 10 degrees at birth decreased by age 9 months but increased thereafter if the patient's MM level was higher than L3. In the thoracic/L1-L3 level patients, the mean fixed flexion contracture was 18 degrees with and 17 degrees without knee flexor spasticity. Range of knee flexion remained at 126 degrees until age 3 years, and decreased thereafter if the patient's MM was higher that L3. This study demonstrates that muscle imbalance and spasticity play a minimal role in development of knee contracture.