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Sequence of flexion contracture development in the lower limb: a longitudinal analysis of 1,071 children with

Erika Cloodt1,2, Anna Lindgren3, Henrik Lauge-Pedersen4

  • 1Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. erika.cloodt@med.lu.se.

BMC Musculoskeletal Disorders
|July 2, 2022
PubMed

Insights

Contractures in children with cerebral palsy (CP) often appear in predictable patterns. Understanding these sequences, especially related to hip, knee, and ankle contractures, can guide early intervention for improved mobility.

Area of Science:

  • Orthopedics
  • Pediatric Rehabilitation
  • Movement Science

Background:

  • Cerebral palsy (CP) frequently leads to contractures, impacting joint range of motion and function.
  • Early identification and management of contractures are essential to prevent secondary complications and preserve joint function in children with CP.

Purpose of the Study:

  • To investigate the sequential development of hip, knee, and ankle contractures in children with CP.
  • To determine the association between primary contracture location and the subsequent development of contractures in adjacent joints.

Main Methods:

  • Longitudinal cohort study of 1,071 children with CP, followed for an average of 4.6 years.
  • Analysis included 1,636 legs with initial hip, knee, or ankle flexion contracture (≥10°).
  • Cox proportional-hazards models adjusted for Gross Motor Function Classification System (GMFCS) levels were used.

Main Results:

  • A second contracture developed in 44% of legs, increasing with higher GMFCS levels.
  • Primary hip or foot contractures were associated with a higher likelihood of developing a secondary knee contracture.
  • Primary knee contractures often preceded the development of hip or ankle contractures.

Conclusions:

  • Lower limb contractures in CP exhibit specific sequential patterns.
  • The GMFCS level and the location of the initial contracture significantly influence the development of subsequent contractures in adjacent joints.
Abstract

Keywords:
Cerebral palsyContractureFootHipJointKneeRange of motion

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