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Relationship between radiographic patella-alta pathology and walking dysfunction in children with bilateral spastic

Matthias Hösl1, Harald Böhm2, Michaela Seltmann3

  • 1Schön Klinik Bad Aibling, Hospital for Neurology and Neurological Rehabilitation, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany.

Gait & Posture
|November 18, 2017
PubMed

Insights

Traditional X-ray indices for patella-alta are not informative for walking dysfunction in Cerebral Palsy (CP). Smaller quadriceps moment-arms, not traditional indices, are key to understanding knee pathology and gait abnormalities in CP patients.

Area of Science:

  • Orthopedics
  • Biomechanical Engineering
  • Pediatric Neurology

Background:

  • Patella-alta is prevalent in Cerebral Palsy (CP) patients.
  • Existing diagnostic indices for patella-alta lack specific correlation with CP-related walking dysfunction.

Purpose of the Study:

  • To investigate the relationship between radiographic measurements of patella-alta and gait parameters in children with CP.
  • To determine the clinical utility of traditional patella-alta indices in assessing CP-related knee pathology.

Main Methods:

  • Retrospective analysis of 33 participants with bilateral spastic CP (ages 4-20, GMFCS I-II).
  • 3D gait analysis and radiographic examination including measurements of patellar tendon length, moment arms, and tilt angle.
  • Correlation analysis between radiographic parameters and spatiotemporal gait parameters, knee kinematics, moments, and impulse.

Main Results:

  • Smaller quadriceps moment-arms correlated with slower walking speed and reduced knee extension.
  • Reduced moment-arms and longer patellar tendons were associated with increased knee flexion moment impulse, indicating abnormal knee loading.
  • Traditional patella-alta indices (Caton-Deschamps, Insall-Salvati, Koshino) showed no significant relationship with any gait parameters.

Conclusions:

  • Traditional radiographic indices for patella-alta have limited value in evaluating walking dysfunction in CP.
  • Quadriceps moment-arm length is a critical indicator of patellofemoral pathology in CP, impacting the knee extensor mechanism.
  • Current indices fail to adequately capture biomechanical alterations relevant to gait in CP.
Abstract

Keywords:
Cerebral palsyCrouch gaitKoshino-IndexMoment armsPatella-altaPatellar-tendon

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