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Published on: November 9, 2018
Recurrence of knee flexion contracture after surgical correction in children with cerebral palsy
Supitchakarn Cheewasukanon1, Phatcharapa Osateerakun2, Noppachart Limpaphayom3,4
1School of Medicine, Mae Fah Luang University, Muang District, Chiang Rai, 57100, Thailand.
Insights
Recurrent knee flexion contracture in children with cerebral palsy is more likely in older patients and those requiring posterior knee capsulotomy. Optimizing surgical age and procedure selection can minimize recurrence risks.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Cerebral Palsy Research
Background:
- Knee flexion contracture (FC) and crouch gait are significant challenges in managing children with cerebral palsy (CCP).
- Recurrence of knee FC post-surgery is a serious complication impacting functional outcomes.
Purpose of the Study:
- To identify key factors associated with the recurrence of knee flexion contracture after surgical correction in children with cerebral palsy.
Main Methods:
- Retrospective review of 62 CCP patients (122 knees) undergoing surgery for knee FC.
- Kaplan-Meier analysis and Cox proportional hazard modeling were used to assess recurrence factors.
- Analysis included age at operation, surgical procedures (hamstring lengthening, posterior capsulotomy, femoral osteotomy), and follow-up duration.
Main Results:
- Recurrence of knee FC was observed in 30% of operated knees (37/122) within an average of 4.9 years.
- Factors significantly associated with recurrence included older age at operation (HR 1.19) and the necessity of posterior knee capsulotomy (HR 4.53).
Conclusions:
- Older age at the time of surgery and the performance of posterior knee capsulotomy are linked to recurrent knee FC in CCP.
- Optimizing surgical timing and judiciously selecting surgical procedures are crucial to reduce post-operative muscle weakness and prevent recurrence.
Purpose:
Knee flexion contracture (FC) and crouch gait are challenging to treat in children with cerebral palsy (CCP), and recurrent knee FC after surgery is a severe complication. The aim was to identify factors associated with recurrent knee FC after surgery.
Methods:
The records of 62 CCP (age 10.6±2.6 years) who underwent surgery and were followed for > six months were reviewed. Knee FC was treated by hamstring lengthening, posterior knee capsulotomy, and femoral shortening/extension osteotomy until full extension was obtained. Kaplan-Meier analysis was used to estimate the probability of the correction being maintained. Cox proportional hazard modeling was used to compare parameters between patients with and without recurrent knee FC, with the time to recurrence as the endpoint. Potential confounding factors were included in the multivariate analysis.
Results:
In total, the procedure was performed on 122 knees. The average weight-for-age z score was -1.3±1.2. The average follow-up period was 5.4±4.2 years. Knee FC recurrence was observed in 37 knees (30%). The average recurrence-free time was 4.9 years, with most cases of recurrence (33 knees) occurring within six years after surgery. The factors associated with recurrence were age (HR, 1.19) and a required posterior knee capsulotomy procedure (HR, 4.53).
Conclusion:
Recurrent knee FC after correction is associated with CCP who are older at the time of operation and when posterior knee capsulotomy is performed. The age at operation should be optimized. The sequence of procedures should be performed only as necessary to minimize the chance of post-operative muscle weakness and recurrence.
