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Does additional patella tendon shortening influence the effects of multilevel surgery to correct flexed knee gait in

M C M Klotz1, Britta K Krautwurst1, K Hirsch1

  • 1Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.

Gait & Posture
|December 26, 2017
PubMed

Insights

Patellar tendon shortening (PTS) effectively corrects flexed knee gait in children with cerebral palsy (CP) when combined with single event multilevel surgery (SEMLS). However, this intervention may increase anterior pelvic tilt and lead to a stiff knee gait.

Area of Science:

  • Orthopedic surgery
  • Pediatric rehabilitation
  • Gait analysis

Background:

  • Flexed knee gait is a common challenge in children with cerebral palsy (CP).
  • Single Event Multilevel Surgery (SEMLS) is a surgical approach to address gait abnormalities.
  • The role of Patellar Tendon Shortening (PTS) as an adjunct to SEMLS for improving knee extension requires further investigation.

Purpose of the Study:

  • To evaluate the efficacy of Patellar Tendon Shortening (PTS) as part of SEMLS in reducing flexed knee gait in children with CP.
  • To determine if PTS, when combined with SEMLS, leads to a stiff knee gait.
  • To assess the impact of PTS on knee extension and other clinical parameters post-surgery.

Main Methods:

  • A randomized controlled study involving 22 children with CP and flexed knee gait (GMFCS Level I-III).
  • Participants were allocated to two groups: SEMLS with PTS and SEMLS without PTS.
  • Kinematic data (3-D motion analysis) and clinical assessments were compared before and after surgery (12.7 ± 1.6 months follow-up).

Main Results:

  • Both groups showed significant improvement in maximum knee extension post-SEMLS.
  • The SEMLS + PTS group demonstrated significantly greater correction in knee extension (37.6° to 11.4°) compared to SEMLS alone (35.1° to 21.8°).
  • The SEMLS + PTS group also showed a significant decrease in peak knee flexion and improvements in knee flexion contracture and popliteal angle, with a trend towards increased anterior pelvic tilt.

Conclusions:

  • Patellar tendon shortening (PTS) is effective in correcting flexed knee gait and knee flexion contracture, leading to improved stance phase knee extension in children with CP.
  • While beneficial for knee extension, the addition of PTS to SEMLS may result in a stiff knee gait.
  • An increased anterior pelvic tilt was observed following surgery in both groups, with a trend towards a higher increase in the PTS group.
Abstract

Keywords:
Cerebral palsyChildrenFlexed knee gaitMotion analysisPatellar tendon shorteningRandomized controlled trial

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