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[Spastic knee flexion deformity. Results of surgical treatment]
J C Pouliquen1, P Lacert, Y Durand
1Service de Chirurgie Orthopédique Infantile, Hôpital Raymond Poincare, Garches.
Insights
Surgical interventions for spastic knee flexion deformity in children can improve function, particularly in those who can walk or have recently stopped walking. Careful patient selection based on muscle strength and nerve response is crucial for successful outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Neuromuscular Disorders
Context:
- Spastic knee flexion deformity is a common complication in children with cerebral palsy and other neuromuscular conditions.
- Surgical correction aims to improve knee extension and overall lower limb function.
- Previous studies have evaluated various surgical techniques with mixed results.
Purpose:
- To evaluate the effectiveness of surgical procedures for spastic knee flexion deformity in children.
- To compare the outcomes of modified Eggers' operation, patellar lowering, and combined procedures.
- To identify factors influencing surgical success, including muscle strength and follow-up duration.
Summary:
- This study reviewed 36 children who underwent surgery for spastic knee flexion deformity.
- Procedures included modified Eggers' operation, patellar lowering, or a combination.
- Improvement was observed, particularly in ambulatory patients or those with recent ambulation cessation, correlating with muscle status and follow-up length.
Impact:
- Surgical outcomes are most favorable in children with existing or potential for ambulation.
- Systematic pre-operative assessment, including muscle strength and nerve block response, is essential for guiding surgical indications.
- These findings can help optimize treatment strategies for pediatric spastic knee flexion deformity.
Abstract:
The records of 36 children who had been treated surgically for spastic knee flexion deformity were studied. The procedures were either a modified Eggers' operation, a lowering of the patella or a combination of both. Thirty-three children were reviewed at a distance and a comparison made between their initial and final function. The results were also assessed in relation to the state of the muscles and the length of follow-up. Many patients were improved but this improvement could not reasonably be expected except in those who could walk or in whom walking had been abandoned for a short time. The indications for the type of procedure should follow systematic examination by a medical and surgical team, taking account of the strength of the gluteus maximus and the quadriceps and the response to novocaine infiltration of the sciatic nerve.