Article

Multilevel surgical intervention is a common approach for the
correction of gait abnormalities in children with cerebral palsy (CP). The
short-term outcomes for the combination of rectus femoris transfer, hamstring
lengthening and gastrocnemius lengthening have been well documented using
three-dimensional motion analysis. However, the impact of time, growth, and
puberty on these short-term outcomes of this combination of procedures is not
well understood. The purpose of this study was to evaluate the long-term outcomes
of these procedures on gait in patients with CP. METHODS: Twenty-two patients
underwent rectus femoris transfers, medial hamstring lengthenings and
gastrocnemius lengthenings in combination with a selection of other soft tissue
and/or bony procedures of the lower limb. All patients had a pre-operative motion
analysis and post-operative analysis one and 11 years following surgery. RESULTS:
Significant changes in both clinical and gait variables from pre to 1 year post
surgery confirmed the short-term gait benefits of this combination of surgical
procedures. Long-term follow-up data indicated that the passive range of motion
gains noted 1 year after surgery were lost at the knee and ankle. However, the
improvements in ankle dorsiflexion and knee extension at initial contact were
maintained over 11 years. As well, peak ankle dorsiflexion in stance was
maintained and peak ankle plantar flexor moments and powers did not show declines
long-term. Peak knee flexion showed a decline over the long-term, however, the
timing of peak knee flexion in swing was maintained. CONCLUSION:
When compared to
declines in gait kinematics in persons with CP without surgery, these results
demonstrate the possible long-term benefits of surgical intervention.
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Langue : ANGLAIS