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What happens to the patella height in patients with cerebral palsy as they age
Jae Jung Min1, Soon-Sun Kwon2, Ki Hyuk Sung1
1Department of Orthopaedic Surgery, Seoul National University Bundang Hospital.
Insights
Patella alta (PA) in cerebral palsy (CP) patients generally improves with age across all GMFCS levels. However, severe CP (GMFCS IV-V) indicates a risk of progressive patella alta, impacting knee health.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Radiology
Background:
- Patella alta (PA) is a common condition in pediatric patients with cerebral palsy (CP).
- The Koshino-Sugimoto (KS) index is a radiographic measure used to assess patellar height.
- Understanding PA progression in CP is crucial for managing orthopedic complications.
Purpose of the Study:
- To investigate the longitudinal progression of patella alta in pediatric cerebral palsy patients.
- To evaluate the Koshino-Sugimoto (KS) index changes over time in relation to age and GMFCS level.
- To identify risk factors associated with patella alta progression in this population.
Main Methods:
- Retrospective analysis of 222 pediatric CP patients with over 2 years of follow-up.
- Measurement of Koshino-Sugimoto (KS) index from 652 lateral knee radiographs.
- Application of a linear mixed model to analyze KS index changes with age and GMFCS levels.
Main Results:
- The KS index generally decreased with age across all Gross Motor Function Classification System (GMFCS) levels, indicating improvement in patellar height.
- A statistically significant increase in the KS index (worsening PA) was observed in patients with GMFCS levels IV and V.
- Reference values for the KS index were established for ages 4-18, stratified by GMFCS level.
Conclusions:
- Patella alta tends to improve with age in most pediatric CP patients, regardless of GMFCS level.
- Patients with severe CP (GMFCS IV-V) are at higher risk for progressive patella alta.
- These findings highlight the importance of monitoring patellar height in CP patients, particularly those with severe motor impairment.
Abstract:
We aimed to investigate the progression of patella alta (PA) in patients with cerebral palsy (CP) using the Koshino-Sugimoto (KS) index and assess associated risk factors. Participants in our retrospective study met the following inclusion criteria: patients with CP who visited our institute from May 2003 to December 2019, were ≤18 years of age, were followed up for >2 years and had at least two lateral knee radiographs. KS indices of both knee radiographs were measured for each patient. A linear mixed model was implemented. Our participants included 222 CP patients. KS index values were measured via 652 knee radiographs. Reference values of the KS index for those between 4 and 18 years of age were determined according to Gross Motor Function Classification System (GMFCS) levels. In all GMFCS levels, the KS index decreased with patients' ages (P < 0.0001). In groups where the KS index increased, GMFCS levels IV (P = 0.0045) and V (P = 0.0040) were statistically significant. Change in the KS index values indicates that PA improves as patients age within all GMFCS levels. However, in patients with GMFCS levels of IV and V, progressive PA is expected.
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