Prevalence of knee contractures is high in children with cerebral palsy in Denmark
André Nis Klenø1,2, Martin Bækgaard Stisen1,2, Claes Høgh Cubel1,2
1Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.
Insights
Knee contractures are common in children with cerebral palsy (CP), particularly in older children and those with severe mobility issues. This study found no link between contractures and spasticity levels in Danish children with CP.
Area of Science:
- Neurology
- Pediatrics
- Orthopedics
Background:
- Cerebral palsy (CP) is a neurological condition affecting children's motor function.
- Knee contractures are a known complication in children with CP, impacting mobility.
- Previous research indicated associations between knee contractures, Gross Motor Function Classification System (GMFCS) levels, age, and spasticity.
Purpose of the Study:
- To investigate the prevalence of knee contractures in a Danish pediatric CP population.
- To examine the association between knee contractures and GMFCS levels, age, and spasticity (Modified Ashworth Scale - MAS) in children with CP.
Main Methods:
- Cross-sectional study of 1,163 children with CP (aged 0-15 years) from the Danish National Cerebral Palsy Registry (2017-2019).
- Prevalence estimation of knee contractures.
- Logistic regression analysis to determine associations with GMFCS, age, and MAS, reporting odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- A high prevalence of knee contracture was observed in 44% of the studied children.
- Significant associations were found between knee contractures and higher GMFCS levels (IV and V) compared to level I.
- Increased age (4-12 years) was significantly associated with a higher prevalence of knee contractures; however, no significant association was found with higher MAS scores.
Conclusions:
- Knee contractures are highly prevalent in Danish children with CP.
- The findings confirm significant associations between knee contractures, higher GMFCS levels, and increased age up to 12 years.
- Unlike previous studies, this research did not find an association between knee contractures and spasticity levels (MAS) in this population.
Introduction:
Cerebral palsy (CP) is a neurological disease occurring in children at early gestation, often resulting in pronounced functional limitations. A Swedish cross-sectional study (Cloodt, et al., 2018) discovered that 22% of children with CP had a knee contracture, which was associated with higher levels of Gross Motor Function Classification System (GMFCS), higher age, and higher levels of spasticity measured by the Modified Ashworth Scale (MAS). The current study investigated these associations in a Danish population.
Methods:
This is a cross-sectional study including 1,163 children with CP aged 0-15 years, registered in the Danish National Cerebral Palsy Registry between 2017 and 2019. Prevalence of knee contracture was estimated, and logistic regression analysis was applied with results presented as odds ratio (OR) with 95% confidence intervals (CI).
Results:
A total of 511 children with CP had knee contracture resulting in a prevalence of 44%. Age groups 4-6 years (OR: 1.73, CI: 1.19; 2.52), 7-9 years (OR: 1.85, CI: 1.29; 2.66) and 10-12 years (OR: 2.12, CI: 1.39; 3.24) were significantly associated with a higher prevalence of knee contractures compared to age group 0-3 years. Knee contractures were significantly more frequent at GMFCS levels IV (OR: 1.9, CI: 1.21; 2.97) and V (OR: 3.62, CI: 2.36; 5.55) compared to level I. Knee contractures were not associated with higher levels of MAS.
Conclusions:
Knee contractures are highly prevalent and significantly associated with high levels of GMFCS and increased age until 12 years, but not with high levels of spasticity in children with CP in Denmark.
