Related Experiment Video
Updated: Apr 25, 2026
Enhancing the Development and Growth of Infant Cerebral Palsy Rats Using Selective Spinal Manipulations
Published on: February 2, 2024
Knee Pain and Patellofemoral Symptoms in Patients With Cerebral Palsy
Susan A Rethlefsen1, Danny T Nguyen, Tishya A L Wren
1*Children's Orthopaedic Center, Children's Hospital †Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA ‡Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, CT.
Insights
Knee pain affects 21% of children with cerebral palsy (CP), being more common in females and older children. This study identified key factors contributing to knee pain in this population.
Area of Science:
- Orthopedics
- Pediatric Rehabilitation
- Biomechanical Engineering
Background:
- Knee pain in cerebral palsy (CP) is linked to increased patellofemoral forces during walking.
- Common pediatric conditions like obesity, genu valgum, and torsional abnormalities may exacerbate knee issues in CP.
- Understanding CP-specific knee pain factors is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of knee pain and patellofemoral dysfunction in children with CP.
- To identify physical and gait characteristics predisposing children with CP to knee problems.
- To analyze 3-dimensional gait analysis data for insights into knee pain etiology.
Main Methods:
- Retrospective review of 121 children with CP (Gross Motor Function Classification System levels I-IV).
- Utilized computerized gait analysis to assess hip, knee, and ankle kinematics.
- Compared demographics, range of motion, and body mass index between subjects with and without knee pain.
Main Results:
- 21% of children with CP reported knee pain; patellar subluxation/dislocation was rare (2%).
- Knee pain prevalence was significantly higher in females (40%) vs. males (10%) and increased with age.
- Malignant malalignment syndrome showed a potential link to more severe knee pain; BMI and stance knee flexion were not significant factors.
Conclusions:
- Approximately 21% of ambulatory children with CP experience knee pain.
- Knee pain in CP is more prevalent in females and older children.
- Knee pain is not solely explained by common malalignments; age and sex are key predictors.
Background:
Knee pain in cerebral palsy (CP) is associated with increased patellofemoral forces present when walking with flexed knees. In typically developing children, knee pain and patellofemoral dysfunction are associated with obesity, genu valgum, femoral anteversion, and external tibial torsion. These problems are also common in CP, and may contribute to knee problems in this population. The purposes of this study were to define the prevalence of knee pain and patellofemoral dysfunction in children with CP, and to identify physical and gait characteristics (using 3-dimensional gait analysis data) that predispose them to such problems.
Methods:
Retrospective review of 121 children with CP, Gross Motor Function Classification System level I to IV, who underwent computerized gait analysis testing. Demographics, range of motion, body mass index and hip, knee, and ankle kinematics were compared between subjects with and without knee pain.
Results:
Twenty-five of 121 subjects (21%) reported knee pain at the time of testing. Three of 121 subjects (2%) had a history of patellar subluxation/dislocation. Age and sex were significantly related to presence of knee pain. The likelihood of knee pain was almost 5 times higher in females (odds ratio=4.9, [95% confidence interval, 1.8-13.3], P=0.002), with a prevalence of 40% (17/42) in females versus 10% (8/79) in males. The likelihood of knee pain increased with age by approximately 13% per year (odds ratio=1.13, [95% confidence interval, 1.00-1.28], P=0.058). Malignant malalignment syndrome showed a potential relationship to more severe knee pain (P=0.05), which warrants further investigation. Body mass index, pes valgus, and degree of stance knee flexion showed no statistically significant relationships to knee pain (P>0.16).
Conclusions:
The prevalence of knee pain in ambulatory patients with CP is approximately 21%. Patellar subluxation (2%) and dislocation are rare in these patients. Knee pain is not always related to crouch, femoral anteversion, external tibial torsion, genu valgum, or pes valgus. Knee pain in these patients is more prevalent in females, and increases with increasing age.
Level Of Evidence:
Level III-case-control study.
More Related Videos
08:26Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy
Published on: January 11, 2016
07:20Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Related Concept Videos
01:16Bones of the Lower Limb: Femur and Patella
01:23Knee Joint
A total of seven ligaments support the knee joint. The patellar ligament, which is also attached to the quadriceps femoris...
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation