Does patella lowering improve crouch gait in cerebral palsy? Comparative retrospective study

Area of Science:

• Orthopedic surgery
• Pediatric rehabilitation
• Gait analysis

Background:

• Crouch gait in cerebral palsy (CP) is often treated with multilevel surgery.
• Patella lowering aims to enhance quadriceps function for gait correction.
• Limited research exists on patella lowering as part of multilevel CP surgery.

Purpose of the Study:

• To evaluate the effectiveness of patella lowering in children with CP and crouch gait.
• To compare gait parameters in patients who underwent patella lowering versus those who did not.

Main Methods:

• Retrospective study of 12 lower limbs with patella alta in 41 children with CP.
• Patella lowering was performed without distal femoral osteotomy or hamstring release.
• Propensity score matching was used to select controls with similar procedures but without patella lowering.

Main Results:

• Patellar lowering significantly improved minimum knee flexion at mid-stance (-24° vs. -12°).
• Knee flexion contracture improved only in the patellar lowering group.
• Gait Deviation Index and extension lag showed no significant difference between groups.

Conclusions:

• Patellar lowering is effective in reducing knee flexion at mid-stance for CP patients with patella alta and crouch gait.
• The procedure appears safe and does not negatively impact overall gait.
• Results may not be generalizable to patients without patellar height issues.