3-D lower extremity bone morphology in ambulant children with cerebral palsy and its relation to gait

Changes in lower-extremity bone morphology are potential mid- to long-term secondary consequences of cerebral palsy (CP), affecting activity. Little is known about the 3-D morphology of lower-extremity bones in children with CP and the association with gait deviations. The main aim of this study was to describe and compare 3-D lower-extremity bone morphology in ambulant children with unilateral or bilateral CP. Secondary aims were to determine whether certain bone parameters were related to the unilateral or bilateral CP and to quantify the association between bone parameters and gait deviations. Among 105 ambulant children with CP (aged 3 to 17 years), 48 had bilateral CP (Bilat-CP) and 57 had unilateral CP (Unilat-CP); the unaffected limb of children with Unilat-CP was used as control limbs. Fifteen bone parameters were calculated by EOS® biplanar radiography, and the Gait Deviation Index (GDI) was calculated by 3-D gait analysis. Data were compared by descriptive and comparative statistical analysis (Anova, principal component analysis [PCA] and focused-PCA). Mean (SD) neck shaft angle was significantly greater for Unilat-CP than control limbs (134.9° [5.9] vs. 131.3° [5]). Mean mechanical tibial angle was significantly smaller (85.8° [6.7] vs. 89° [4.6]) and mean femoral torsion was significantly greater (29.4° [1.6] vs. 19.1° [11.8]) for Bilat-CP than control limbs. On PCA of the main determinants of 3-D bone morphology, bone shape was more complex with Bilat-CP, with changes in all 3 dimensions of space, than Unilat-CP and control limbs. Few bone parameters were correlated with the GDI in any limbs. In ambulant children with CP, femoral and tibial growth are not affected by the condition. The unilateral or bilateral nature of CP must be considered during treatment to prevent bone deformities and bone morphology affecting gait quality.