Does additional patella tendon shortening influence the effects of multilevel surgery to correct flexed knee gait in cerebral palsy: A randomized controlled trial.

BACKGROUND: The aims of this study were to investigate if patellar tendon shortening (PTS) as a part of SEMLS (single event multilevel surgery) is effective for reduction of flexed knee gait in children with cerebral palsy (CP) and, if PTS leads to stiff knee gait. METHODS: In a randomized controlled study 22 children with flexed knee gait (age: 10.4 ±â€¯2.6 years, GMFCS Level I-III) were randomized and allocated to two groups (1: SEMLS + PTS; 2: SEMLS no PTS): SEMLS was performed for correction of flexed knee gait either with or without additional PTS. Before and after surgery (follow up: 12.7 ±â€¯1.6 months) kinematics (3-D motion analysis) and clinical parameters were compared. RESULTS: Two children were lost to follow up. Maximum knee extension improved significantly in both groups after SEMLS while the patients with additional PTS showed much more correction (SEMLS + PTS: 37.6° to 11.4°, p = 0.007; SEMLS no PTS: 35.1° to 21.8°, p = 0.016). After surgery peak knee flexion decreased significantly (14.6°, p = 0.004) in the "SEMLS + PTS" group while there was no relevant change in the other group. There was a trend of increase in anterior pelvic tilt after surgery in both groups, but no statistical significant difference. After surgery knee flexion contracture (15.9°, p < 0.001) and popliteal angle (27.2, p = 0.009) measured on clinical examination only decreased significantly in the "SEMLS + PTS" group. CONCLUSION: PTS is effective for correction of flexed knee gait and knee flexion contracture leading to superior stance phase knee extension. However, additional PTS may lead to stiff knee gait and a higher increase of anterior pelvic tilt.

Reduction in primary genu recurvatum gait after aponeurotic calf muscle lengthening during multilevel surgery.

Knee hyperextension (genu recurvatum, GR) is often seen in children with bilateral spastic cerebral palsy (CP). Primary GR appears essential without previous treatment. As equinus deformity is suspected to be one of the main factors evoking primary GR, the purpose of this study was to determine whether lengthening the calf muscles to decrease equinus would decrease coexisting GR in children with bilateral spastic CP. In a retrospective study, 19 CP patients with primary GR (mean age: 9.4 years, 13 male, 6 female, 26 involved limbs) in whom an aponeurotic calf muscle lengthening procedure was performed during single-event multilevel surgery were included and investigated using three-dimensional gait analysis before and at a mean follow-up of 14 months after the procedure according to a standardized protocol. After calf muscle lengthening, a significant improvement in ankle dorsiflexion (9.5°) and a significant reduction (10.5°) in knee hyperextension (p<0.001) were found during mid-stance of the gait cycle. Six limbs (23%) showed no improvement concerning knee hyperextension and were designated as nonresponders. In these patients no significant improvement in ankle dorsiflexion was found after surgery either. Improvement in ankle dorsiflexion and reduction in knee hyperextension in stance phase correlated significantly (r=0.46; p=0.019). These findings indicate that equinus deformity is a Major underlying factor in Primary GR and that calf muscle lengthening can effectively reduce GR in patients with CP.

Motion capture of the upper extremity during activities of daily living in patients with spastic hemiplegic cerebral palsy.

Investigations using motion capture to analyze limitations in range of motion (ROM) of the upper extremity in adults with cerebral palsy (CP) are scarce. To evaluate the influence of those limitations on activities of daily living (ADL) and to determine potential mechanisms of compensation, we investigated 15 adults with hemiplegic CP using motion capture while they performed 10 defined ADLs. Data from the nonaffected body side and those from an age-matched able-bodied group were also collected and compared with our subjects. We measured motion of the elbow, shoulder, and trunk and found significant differences in ROM at these sites. The most pronounced reduction in ROM was observed distally in supination and pronation of the elbow. Here, the affected body side of the adults showed a reduction in supination of 45° compared to the able-bodied group. Furthermore we found a correlation between the Manual Ability Classification System (MACS) and the limitations in ROM. In summary, adults with spastic, hemiplegic CP show limitations in ROM accentuated distally during ADLs. The MACS gives conclusive information about those limitations.

[Results of 5 to 10-year follow-up after hip resurfacing. A systematic analysis of the literature on long-term results]. / Fünf- bis Zehn-Jahresergebnisse für den Oberflächenersatz des Hüftgelenks. Eine systematische Literaturanalyse der mittelfristigen Standzeiten.

Hip resurfacing is a common method for therapy of coxarthritis and is currently under discussion. The aim of this study was to analyze hip resurfacing follow-up studies with more than 5 years follow-up time. A total of 17 studies which matched the inclusion criteria were analyzed. The survival rate after 5-6 years was 96.3%, after 7-8 years 93.8% and after 9-10 years 90%. Young men with primary coxarthritis and surgery by an experienced surgeon showed the best results. The main causes for revision were aseptic loosening with 34.4% and fracture of the proximal femur with 31.9%. Dislocation as a cause for revision was rare and occurred in 2.8% of all cases. Hip resurfacing showed worse results than conventional hip arthroplasty. The risk for complications was high especially for women, with small prostheses and in patients with suboptimal positioning of the prosthesis.