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Knee surveillance for ambulant children with cerebral palsy
Pam Thomason1, Kerr Graham1,2, Ken Ye1
1The Hugh Williamson Gait Laboratory, The Royal Children's Hospital, Parkville, VIC, Australia.
Insights
Knee surveillance (KS) in children with cerebral palsy (CP) aims to detect knee flexion deformities early. This approach allows for less invasive interventions, potentially avoiding higher-risk surgeries for better long-term outcomes.
Area of Science:
- Orthopedics
- Pediatric rehabilitation
- Biomechanical analysis
Background:
- Ambulant children with cerebral palsy (CP) often develop progressive musculoskeletal pathology (MSP).
- Fixed flexion deformity at the knee joint (FFDKn) is a common complication, leading to gait abnormalities and surgical relapse.
- Current surgical interventions for FFDKn carry significant risks and potential for recurrence.
Purpose of the Study:
- Introduce the concept of "knee surveillance" (KS) for ambulant children with CP.
- Define KS as systematic, repeated assessment of gait and knee range of motion until skeletal maturity.
- Advocate for early detection and intervention of FFDKn to improve long-term outcomes.
Main Methods:
- Literature review of CP assessment, knee surgery indications, and anterior distal femur hemiepiphysiodesis (ADFH).
- Synthesis of existing evidence to support the preliminary evidence base for KS.
- Conceptual framework development for KS implementation in pediatric CP care.
Main Results:
- Preliminary evidence suggests that combining soft-tissue surgery with ADFH can be effective.
- This combined approach may reduce or eliminate the need for more invasive procedures.
- KS facilitates early intervention, potentially preventing the progression of knee flexion deformities.
Conclusions:
- Knee surveillance (KS) is proposed as a proactive strategy for managing knee deformities in ambulant children with CP.
- KS aims for early detection, minimally invasive intervention, and improved functional outcomes.
- The strategy supports the use of techniques like ADFH to potentially avoid more complex surgeries such as distal femoral extension osteotomy (DFEO) and patellar tendon shortening (PTS).
Purpose:
A majority of ambulant children with cerebral palsy (CP) develop progressive musculoskeletal pathology (MSP) during growth. Fixed flexion deformity at the knee joint (FFDKn) contributes to flexed knee gait and is prone to relapse after index multi-level surgery. This perspective introduces the concept of "knee surveillance" (KS), defined as a repeated systematic assessment of gait and knee range of motion until skeletal maturity. KS aims to detect early FFDKn, allowing for early intervention with minimally invasive techniques such as anterior distal femur hemiepiphysiodesis (ADFH), and reduce the need for higher-risk surgery such as distal femoral extension osteotomy (DFEO) and patellar tendon shortening (PTS).
Methods:
Recent literature on the assessment of ambulant children with CP, consensus statements on indications for dose-based knee surgery, and the indications for ADFH have been reviewed and synthesized. These provide a preliminary evidence base for the concept of KS in ambulant children with CP.
Conclusion:
We propose the concept of KS for ambulant children with CP. The goals of KS are early detection of knee flexion deformity, early intervention, less invasive surgery, and better long-term outcomes. There is preliminary evidence to suggest that soft-tissue surgery, in combination with ADFH, can reduce, or perhaps replace, the need for more invasive surgery such as DFEO and PTS.
Level Of Evidence:
IV.
