Article

Patellar tendon shortening procedure within single event multilevel
surgeries was shown to improve crouch gait in Cerebral Palsy (CP) patients.
However, one of the drawbacks associated to the correction of flexed knee gait
may be increased pelvic anterior tilt with compensatory lumbar lordosis. RESEARCH QUESTION: Which CP patients are at risk for excessive anterior pelvic tilt
following correction of flexed knee gait including patellar tendon shortening?
METHODS: 32 patients with CP between 8 and 18 years GMFCS I&II were included.
They received patellar tendon shortenings within multilevel surgery. Patients
with concomitant knee flexor lengthening were excluded. Gait analysis and
clinical testing was performed pre- and 24.1 (SD=1.9) months postoperatively.
Patients were subdivided into more/less than 5 degrees increase in anterior
pelvic tilt. Preoperative measures indicating m. rectus and m. psoas shortness,
knee flexor over-length, hip extensor and abdominal muscle weakness and equinus
gait were compared between groups. Stepwise multilinear regression of the
response value increase in pelvic tilt during stance phase was performed from
parameters that were significantly different between groups. RESULTS: 34% of
patients showed more than 5 degrees increased pelvic anterior tilt
postoperatively. Best predictors for anterior pelvic tilt from preoperative
measures were increased m. rectus tone and reduced hip extension during walking
that explained together 39% of the variance in increase of anterior pelvic tilt.
DISCUSSION: Every third patient showed considerable increased pelvic tilt
following surgery of flexed knee gait. In particular patients with preoperative
higher muscle tone in m. rectus and lower hip extension during walking were at
risk and both features need to be addressed in the therapy.
CI - Copyright (c) 2017 Elsevier B.V. All rights reserved.

Langue : ANGLAIS