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Published on: March 23, 2019
Impact of single-event multilevel surgery on gait in children with cerebral palsy: A retrospective study
Clara Knaepen1, Virginie Otlet1, Christine Detrembleur1
1UCLouvain [Woluwe], Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab, Avenue Mounier 52, Brussels 1200, Belgium.
Insights
Single-event multilevel surgery (SEMLS) significantly improves gait kinematics in children with cerebral palsy (CP). However, SEMLS does not impact mechanical work or energy cost, warranting further investigation into long-term effects.
Area of Science:
- Orthopedics
- Pediatric Rehabilitation
- Biomechanical Engineering
Background:
- Cerebral palsy (CP) is a leading cause of childhood physical disability, often causing gait and mobility impairments due to musculoskeletal deformities.
- Single-event multilevel surgery (SEMLS) is a standard treatment for CP-related deformities, but its specific effects on gait are not fully understood.
- Existing research often focuses on overall kinematic measurements, leaving a gap in understanding SEMLS's impact on specific gait parameters, mechanical work, and energy expenditure.
Purpose of the Study:
- To evaluate the specific effectiveness of SEMLS on gait kinematics in children with CP.
- To assess the impact of SEMLS on mechanical work and energy cost during gait in pediatric CP patients.
- To provide a detailed analysis of kinematic improvements at different surgical levels addressed by SEMLS.
Main Methods:
- Retrospective study of 37 children with CP (GMFCS I-III) who underwent SEMLS.
- Pre- and 1-year post-operative 3D gait analyses were conducted.
- Key kinematic, mechanical work, and energy cost variables were analyzed using paired statistical tests.
Main Results:
- Significant improvements in ankle dorsiflexion (17°) for equinus gait (p < 0.001).
- Significant improvements in knee extension (13°) for crouch gait (p = 0.002).
- Significant improvements in hip rotation (12°) following femoral derotation osteotomy (p < 0.001).
- No significant changes observed in mechanical work or energy cost post-SEMLS.
Conclusions:
- SEMLS effectively improves gait kinematics across multiple surgical levels in children with CP.
- SEMLS does not demonstrate significant improvements in mechanical work or energy cost.
- Long-term follow-up is necessary to ascertain the sustained benefits of SEMLS in CP patients.
Background:
Cerebral palsy (CP) is the leading cause of physical disability in childhood and is often associated with musculoskeletal deformities impairing gait and mobility. While single-event multilevel surgery (SEMLS) is considered the standard approach to correct these deformities, most studies have focused on overall kinematic measurements.
Research Question:
This study aimed to evaluate the specific effectiveness of SEMLS on gait kinematics, mechanical work and energy cost in CP children.
Methods:
Thirty-seven CP children (mean age 13 ± 3 years, GMFCS I-III) who underwent SEMLS between 2002 and 2022 were included in this retrospective study. All patients had pre- and 1-year post-operative 3D gait analyses. Key kinematic variables were selected to assess the different levels addressed by surgery, that changed from child to child. Mechanical and energetic variables were also assessed. Pre- and post-operative data were compared using paired statistical tests (p ≤ 0.05).
Results:
Ankle kinematics improved by 17° in dorsiflexion (p < 0.001) in children with equinus. In children with crouch gait, knee extension improved by 13° (p = 0.002). When a femoral derotation osteotomy was performed, hip rotation improved by 12° (p < 0.001). No significant changes were found in mechanical work or energy cost.
Significance:
SEMLS resulted in significant improvements in gait kinematics in CP children, confirming its global effectiveness across multiple surgical levels. However, no significant impact was found on mechanical work or energy cost. Further follow-up is needed to determine whether the benefits of SEMLS in CP children are sustained or evolve over time.
