Epidemiology of Lower Limb Musculoskeletal Pathology in Cerebral Palsy: A Population-Based, Cohort Study
Tara Korbal1,2, Kerr Graham1,3, Sharmala Thuraisingam1,4
1Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
Insights
Musculoskeletal pathology (MSP) is common in children with cerebral palsy (CP). Its prevalence and type evolve with age and are linked to CP severity, impacting lower limb development.
Area of Science:
- Orthopedics
- Pediatrics
- Neurology
Background:
- Musculoskeletal pathology (MSP) is a common complication in children with cerebral palsy (CP), affecting lower limb development over time.
- Understanding the long-term epidemiology of MSP in CP is crucial for effective management and intervention.
Purpose of the Study:
- To investigate the epidemiology of lower limb musculoskeletal pathology (MSP) in a large, population-based sample of children with cerebral palsy (CP).
- To analyze the long-term progression and prevalence of MSP in relation to age and CP severity.
Main Methods:
- An inception cohort of children with CP was established from the Victorian Cerebral Palsy Register (birth years 1990-1992).
- Participants underwent regular clinical and radiographic examinations from infancy to skeletal maturity.
- Cerebral palsy was classified using the Gross Motor Function Classification System (GMFCS) and a Topographical Classification System (TCS); MSP was classified using a reliable system.
Main Results:
- A dataset of 292 individuals (78% of the cohort) with a mean follow-up age of 20 years was analyzed.
- MSP types showed age-dependent changes: hypertonia (5 years), contractures (10 years), contractures with bony torsion (15 years), and decompensation (25 years).
- Significant associations were found between GMFCS/TCS classifications and MSP types (Kendall's tau 0.36-0.55, p < 0.001).
Conclusions:
- The prevalence of MSP in children with CP followed into their third decade is high.
- MSP development and type are significantly related to the child's age and the severity of their cerebral palsy (CP) as defined by GMFCS.
Background:
Musculoskeletal pathology (MSP) develops in the lower limbs of the majority of children with cerebral palsy (CP) with time and growth. The aims of this study were to investigate the epidemiology of MSP in the lower limbs, of a large population-based sample of children with CP, at long-term follow up.
Methods:
An inception cohort was generated from the Victorian Cerebral Palsy Register for the birth years 1990 through 1992 inclusive. Children had regular clinical and radiographic examinations from infancy until after skeletal maturity. Cerebral palsy was classified using the Gross Motor Function Classification System (GMFCS) and a Topographical Classification System (TCS), devised for this study. MSP was classified using the Musculoskeletal Pathology Classification System, which has good reliability.
Results:
A full dataset was available for 292 individuals, 78% of the inception cohort (170 males, 122 females). Mean age at final follow-up was 20 years (SD 4.5, range 6-31 years). MSP type changed with age. Hypertonia (MSP 1) was present in 77% of children at age 5 years, contractures (MSP 2) in 22% of children at 10 years, contractures combined with bony torsion (MSP 3) in 31% of teenagers at age 15 years, and decompensation (MSP 4) in 15% of young adults at age 25 years. There were moderate to strong associations between GMFCS and MSP and TCS and MSP (Kendall's tau 0.36-0.55, p < 0.001).
Conclusions:
The prevalence of MSP in children with CP who were born between 1990 and 1992 and followed into the third decade was high and was related to age and CP severity by GMFCS.
Level Of Evidence:
Level IV. See Instructions for Authors for a complete description of levels of evidence.
