Article

Adverse effects such as increased anterior pelvic tilt (APT) are reported after
muscle-tendon lengthening (MTL) for the correction of flexed knee gait in
cerebral palsy. The conversion of biarticular muscles (CBM) to monoarticular
muscles represents an alternative treatment, but only few short-term results have
been published, without comparison with MTL. The long-term outcome of 21 diplegic
patients treated with CBM in a prospective study was compared with the results in
MTL patients in a matched-pair analysis. Standardized clinical examination and
three-dimensional gait analysis were done before surgery, 1 year thereafter, and
at long-term follow-up a mean of 9.2 years postoperatively. Mean APT increased
one year after surgery in both groups. This increase was higher in MTL patients
and statistically significant only for this group. Knee flexion at initial
contact and minimum knee flexion in stance were significantly decreased in both
groups, while in swing the CBM group tended to show more of a decrease in knee
flexion but at the cost of reduced peak flexion. Both groups showed deterioration
of kinematic knee parameters through to long-term follow-up; the favourable
effects of CBM disappeared, and the two groups displayed comparable average
pelvic and knee kinematics. Considering individual patterns the prevalence of
increased APT was lower in the CBM group 1 year after surgery, indicating that
sparing the semitendinosus may have a positive effect on pelvic stability.
However, after 9 years 30% of the patients in both groups showed increased APT
indicative of persistent hamstring insufficiency. These results demonstrate that
CBM, a significantly more extensive procedure, has no long-term advantage over MTL.
CI - Copyright (c) 2012 Elsevier B.V. All rights reserved.

Langue : ANGLAIS