1
|
Ghandour M, Klotz M, Horsch A. Research trends in the orthopedic surgical management of cerebral palsy: a cross-analytical study of publications in the past decade. Front Neurol 2023; 14:1200893. [PMID: 37681012 PMCID: PMC10482432 DOI: 10.3389/fneur.2023.1200893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Little is known about the trends in orthopedic surgical management of cerebral palsy (CP). In this cross-analytical study we examined alterations in research publications in this field in the past 10 years through four databases. Thus, we divided publications into old (2012-2017) and recent (2018-2022). To determine if the focus of research in this field has changed, we compared both periods based on publication's (authors' number, journal, country, design), patients' (number, gender, age, CP type), and surgery-related (indication, number, category, type) characteristics. Publications showed a positive trend over the past 10 years with a peak in 2020. The number of publications was similar between old and recent ones (47.58% vs. 52.42%). Most research outputs were from the United States and Germany. Differences were noted between recent and old publications regarding journals (p = 0.0001), journal category (p = 0.023), authors' number (p = 0.006), and patients' age (p = 0.02). The impact factor was also different (p = 0.0001). However, no differences were noted regarding other characteristics (p > 0.05). The research output regarding surgical orthopedic management in CP has increased in the past decade with no difference between 2012-2017 and 2018-2022. Except for the number of authors, journal name, and patients' age, no significant differences were noted between both periods.
Collapse
Affiliation(s)
- Maher Ghandour
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Klotz
- Marienkrankenhaus Soest, Orthopedics and Trauma Surgery, Soest, Germany
| | - Axel Horsch
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
2
|
Zimmermann R, Poschmann M, Altschuck N, Bauer C, von Pfeil D, Bernius P, Mall V, Jung NH. Influence of the percutaneous myofasciotomy on gait of children with spastic cerebral palsy - A short term, retrospective controlled analysis. Gait Posture 2023; 104:159-164. [PMID: 37421812 DOI: 10.1016/j.gaitpost.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/19/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND One of the primary causes in children with cerebral palsy (CP) leading to gait disorders is an increased muscle tone which may secondary result in a shortening of the muscle fascia. Percutaneous myofasciotomy (pMF) is a minimal-invasive surgical intervention correcting the shortened muscle fascia and aims to extend the range of motion. RESEARCH QUESTION What is the effect of pMF on gait in children with CP three months and one year post-OP? METHODS Thirty-seven children (f: n = 17, m: n = 20; age: 9,1 ± 3,9 years) with spastic CP (GMFCS: I-III, bilateral (BSCP): n = 24, unilateral (USCP): n = 13) were retrospectively included. All children underwent a three dimensional gait analysis with the Plug-in-Gait-Model before (T0) and three months after pMF (T1). Twenty-eight children (bilateral: n = 19, unilateral: n = 9) underwent a one-year follow-up-measurement (T2). Differences in the Gait Profile Score (GPS), kinematic gait data, gait-related functions and mobility in daily living were statistically analyzed. Results were compared to a control group (CG) matched in age (9,5 ± 3,5 years), diagnosis (BSCP: n = 17; USCP: n = 8) and GMFCS-level (GMFCS I-III). This group was not treated with pMF but underwent two gait analyses in twelve months. RESULTS The GPS improved significantly in BSCP-pMF (16,46 ± 3,71° to 13,37 ± 3,19°; p < .0001) and USCP-pMF (13,24 ± 3,27° to 10,16 ± 2,06°; p = .003) from T0 to T1 with no significant difference between T1 and T2 in both groups. In CG there was no difference in the GPS between the two analyses. SIGNIFICANCE PMF may in some children with spastic CP improve gait function three months as well as for one-year post-OP. Medium and long-term effects, however, remain unknown and further studies are needed.
Collapse
Affiliation(s)
- Regina Zimmermann
- School of Medicine, Social Pediatrics, Technical University of Munich, Munich, Germany; kbo-Kinderzentrum München, Munich, Germany.
| | | | - Natalie Altschuck
- School of Medicine, Social Pediatrics, Technical University of Munich, Munich, Germany; Department Health Sciences, University of Applied Sciences, Fulda, Germany; Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, University of Marburg, Germany
| | | | | | | | - Volker Mall
- School of Medicine, Social Pediatrics, Technical University of Munich, Munich, Germany; kbo-Kinderzentrum München, Munich, Germany
| | - Nikolai H Jung
- School of Medicine, Social Pediatrics, Technical University of Munich, Munich, Germany; kbo-Kinderzentrum München, Munich, Germany.
| |
Collapse
|
3
|
Ariyawatkul T, Halilamien P, Tangwiwat S, Sirivanasandha B, Pangthipampai P, Chotigavanichaya C, Wongcharoenwatana J, Eamsobhana P. Percutaneous hamstring lengthening in cerebral palsy and the risk of neurovascular transection. J Ultrasound 2022; 25:529-533. [PMID: 34993922 PMCID: PMC9402852 DOI: 10.1007/s40477-021-00620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Percutaneous hamstring lengthening is increasingly popular due to its simplicity, fast recovery rate, and low morbidity. Neurovascular anatomy changes due to knee flexion contracture and the precise proximity of peroneal nerve and Biceps femoris tendon are not well established. This study examined (1) the coronal distance between the peroneal nerve and lateral hamstring tendon ("PLD"), and (2) the distance between the popliteal vessels and medial hamstring tendons ("VMD") to determine the safe distance for percutaneous hamstring lengthening. METHODS This prospective study recruited cerebral palsy patients aged under 15 who needed hamstring lengthening. Ultrasonography was performed after the patients were anesthetized. PLDs and VMDs at popliteal angles (PAs) of 40°, 60°, and 80° knee flexions were collected. RESULTS Sixteen patients (32 knees) were enrolled. The mean minimum PLDs at PAs of 40°, 60°, and 80° were 3.5, 4.1, and 3.1 mm, respectively. The peroneal nerve physically touched the lateral hamstring tendon in 5/32 knees (15.6%). The mean minimum VMDs at PAs of 40°, 60°, and 80° were 19, 18.3, and 16.4 mm, respectively. One spastic diplegic patient had a minimum VMD < 3 mm on both sides. Changing the PAs demonstrated no statistical significance for both PLD and VMD (P value = 0.105 and 0.779, respectively). CONCLUSIONS Percutaneous medial hamstring lengthening should be done with caution. We recommend open biceps femoris surgery, with preoperative ultrasonography (to check the PLD) or peroneal nerve palpation to reduce the risk of peroneal nerve transection.
Collapse
Affiliation(s)
- Thanase Ariyawatkul
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Pathom Halilamien
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suwimon Tangwiwat
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Busara Sirivanasandha
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawinee Pangthipampai
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatupon Chotigavanichaya
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Jidapa Wongcharoenwatana
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Perajit Eamsobhana
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
| |
Collapse
|
4
|
Pierz K, Brimacombe M, Õunpuu S. Percutaneous hamstring lengthening in cerebral palsy: Technique and gait outcomes based on GMFCS level. Gait Posture 2022; 91:318-325. [PMID: 34823200 DOI: 10.1016/j.gaitpost.2021.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased knee flexion at initial contact and in stance is a common problem for children with cerebral palsy. Surgical correction with percutaneous hamstring lengthening is an alternative to open hamstring lengthening; however, outcomes are less well documented, and there is concern about increasing anterior pelvic tilt. The purpose of this study was to evaluate the short-term outcomes of percutaneous hamstring lengthenings in children with cerebral palsy using comprehensive gait analysis techniques. RESEARCH QUESTION Does percutaneous hamstring lengthening improve knee function, and do knee and anterior pelvic tilt outcomes vary by GMFCS level? METHODS A convenience sample of 52 patients with both pre and post-surgical gait analyses was evaluated retrospectively for changes in gait function in terms of temporal-spatial parameters, kinematics and kinetics. Patients were divided into two GMFCS subgroups: GMFCS level I/II and III. RESULTS The percutaneous hamstring lengthening results in statistically significant improvements in knee function during gait with increased knee extension at initial contact (mean 32° SD 13° to mean 21° SD 11°, p = 0.000) and improved mean knee flexion in stance (mean 23° SD 12° to mean 16° SD 11°, p = 0.000) for the total study cohort. Beneficial changes were found for knee function in both GMFCS level subgroups; however, there was an increase in pelvic tilt pre to post-surgery in the GMFCS level III subgroup (mean 21° SD 8° to mean 26° SD 6°, p = 0.012) but not the GMFCS level I/II subgroup (mean 18° SD 7° to mean 20° SD 8°, p = 0.427). SIGNIFICANCE Percutaneous hamstring lengthening can improve knee function for all patients; however, the impact on anterior pelvic tilt varies by GMFCS level, with increasing anterior tilt for GMFCS level III only. This study highlights the importance of understanding differences in surgical outcomes by GMFCS level to better predict post-surgical function.
Collapse
Affiliation(s)
- Kristan Pierz
- Center for Motion Analysis, Division of Orthopedics, Connecticut Children's Medical Center, United States; Orthopedic Surgery, University of Connecticut School of Medicine, United States.
| | - Michael Brimacombe
- Research Department, Connecticut Children's Medical Center, United States.
| | - Sylvia Õunpuu
- Center for Motion Analysis, Division of Orthopedics, Connecticut Children's Medical Center, United States; Orthopedic Surgery, University of Connecticut School of Medicine, United States.
| |
Collapse
|
5
|
Skoutelis VC, Kanellopoulos AD, Vrettos SG, Dimitriadis Z, Kalamvoki E, Dinopoulos A, Papagelopoulos PJ, Vrettos SS, Kontogeorgakos VA. Effects of minimally invasive surgery and functional physiotherapy on motor function of children with cerebral palsy: A non-randomised controlled trial. J Orthop 2021; 27:122-129. [PMID: 34616116 DOI: 10.1016/j.jor.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022] Open
Abstract
Purpose This non-randomised controlled trial investigated whether a combined programme of functional physiotherapy and minimally invasive orthopaedic surgery improves the level and degree of capacity and performance of gross motor function in children with spastic cerebral palsy (CP). Methods Fifty-two children with spastic CP aged 5-7 years, Gross Motor Function Classification System (GMFCS) levels II-IV, were allocated to two equal groups: experimental group (selective percutaneous myofascial lengthening [SPML] procedure and 9-month functional strengthening physiotherapy programme) and control (standard physiotherapy) groups. At baseline and at the end of the 9-month intervention, the capacity and performance of gross motor function were assessed with the Gross Motor Function Measure (GMFM) D and E subcategories and Functional Mobility Scale (FMS), respectively. The level of gross motor function was measured with the GMFCS. Results There was a statistically significant difference in the post-intervention improvements in the GMFM D (experimental mean difference = 19.63 ± 10.46; control mean difference = 2.40 ± 4.62) and E (experimental mean difference = 19.33 ± 11.82; control mean difference = 4.20 ± 6.26) between experimental and control group (p < 0.001). There was a significant improvement in the GMFCS level and each FMS distance for the experimental group (p < 0.001), but not for the control group (p > 0.05). Conclusion SPML procedure combined with functional physiotherapy improves gross motor function in children with spastic CP, by raising the degree and level of motor independence.
Collapse
Affiliation(s)
- Vasileios C Skoutelis
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,Laboratory of Neuromuscular & Cardiovascular Study of Motion, Department of Physiotherapy, School of Health and Caring Sciences, University of West Attica, Egaleo, Attica, Greece.,Department of Physiotherapy, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | | | | | - Zacharias Dimitriadis
- Health and Quality of Life Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Efstratia Kalamvoki
- 'Paidokinisi' Pediatric Physiotherapy Practice, Argyroupolis, Attica, Greece
| | - Argirios Dinopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,Third Department of Paediatrics, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | - Panayiotis J Papagelopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,First Department of Orthopaedic Surgery, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | - Stefanos S Vrettos
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Vasileios A Kontogeorgakos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,First Department of Orthopaedic Surgery, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| |
Collapse
|
6
|
Abstract
Muscle-tendon unit surgery for correction of deformities and movement dysfunction in children with cerebral palsy (CP) is fairly complicated. An understanding of basic muscle-tendon unit properties and their adaptation to both CP and surgery are important to develop advances in this field. In this review, we provide information to therapists, surgeons, and scientists regarding the short- and long-term adaptations of the muscle-tendon unit. Surgical releases, lengthening, and transpositions are discussed, as are some of the tissue, cellular, and molecular adaptations. What this paper adds Muscle strength, tone, and control must be considered in surgical interventions for cerebral palsy (CP). Muscle-tendon unit lengthening causes significant and lasting weakness requiring prolonged rehabilitation. Sarcomere length increases in CP muscle may be one of the underlying causes of muscle weakness. Muscle satellite cells are decreased and epigenetically modified in a way that may limit muscle growth in CP.
Collapse
Affiliation(s)
- Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Northwestern University, Chicago, IL, USA.,Hines VA Medical Center, Maywood, IL, USA
| | | |
Collapse
|
7
|
Edwards TA, Thompson N, Prescott RJ, Stebbins J, Wright JG, Theologis T. A comparison of conventional and minimally invasive multilevel surgery for children with diplegic cerebral palsy. Bone Joint J 2021; 103-B:192-197. [PMID: 33380192 DOI: 10.1302/0301-620x.103b1.bjj-2020-0714.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To compare changes in gait kinematics and walking speed 24 months after conventional (C-MLS) and minimally invasive (MI-MLS) multilevel surgery for children with diplegic cerebral palsy (CP). METHODS A retrospective analysis of 19 children following C-MLS, with mean age at surgery of 12 years five months (seven years ten months to 15 years 11 months), and 36 children following MI-MLS, with mean age at surgery of ten years seven months (seven years one month to 14 years ten months), was performed. The Gait Profile Score (GPS) and walking speed were collected preoperatively and six, 12 and 24 months postoperatively. Type and frequency of procedures as part of MLS, surgical adverse events, and subsequent surgery were recorded. RESULTS In both groups, GPS improved from the preoperative gait analysis to the six-month assessment with maintenance at 12 and 24 months postoperatively. While reduced at six months in both groups, walking speed returned to preoperative speed by 12 months. The overall pattern of change in GPS and walking speed was similar over time following C-MLS and MI-MLS. There was a median of ten procedures per child as part of both C-MLS (interquartile range (IQR) 8.0 to 11.0) and MI-MLS (IQR 7.8 to 11.0). Surgical adverse events occurred in seven (37%) and 13 (36%) children, with four (21%) and 13 (36%) patients requiring subsequent surgery following C-MLS and MI-MLS, respectively. CONCLUSION This study indicates similar improvements in gait kinematics and walking speed 24 months after C-MLS and MI-MLS for children with diplegic CP. Cite this article: Bone Joint J 2021;103-B(1):192-197.
Collapse
Affiliation(s)
- Tomos A Edwards
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK
| | - Nicky Thompson
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK
| | - Robin J Prescott
- Centre for Population Health Sciences, Usher Institute, Edinburgh, UK
| | - Julie Stebbins
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK
| | - James G Wright
- Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
8
|
Skoutelis VC, Kanellopoulos AD, Kontogeorgakos VA, Dinopoulos A, Papagelopoulos PJ. The orthopaedic aspect of spastic cerebral palsy. J Orthop 2020; 22:553-558. [PMID: 33214743 DOI: 10.1016/j.jor.2020.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023] Open
Abstract
Spastic Cerebral Palsy (CP) is the most common form of CP, comprising of 80% of all cases. Spasticity is a type of hypertonia that clinically manifests as dynamic contractures. The dynamic contracture along with the reduced level of physical activity in a child with CP leads to secondary structural and morphological changes in spastic muscle, causing real musculotendinous shortening, known as fixed contractures. When fixed muscle contractures are not treated early, progressive musculoskeletal deformities develop. As a consequence, spastic CP from a static neurological pathology becomes a progressive orthopaedic pathology which needs to be managed surgically. Orthopaedic surgical management of CP has evolved from previous "multi-event single level" procedures to a "single event multilevel" procedures, with changes in selection and execution of treatment modalities. There is increasing evidence that multilevel surgery is an integral and essential part of therapeutic management of spastic CP, but more research is needed to ensure effectiveness of this intervention on all domains of physical disability in CP.
Collapse
Affiliation(s)
- Vasileios C Skoutelis
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,Laboratory of Neuromuscular and Cardiovascular Study of Motion, Department of Physiotherapy, School of Health and Care Sciences, University of West Attica, Egaleo, Attica, Greece.,Department of Physiotherapy, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | | | - Vasileios A Kontogeorgakos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,First Department of Orthopaedic Surgery, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | - Argirios Dinopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,Third Department of Paediatrics, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| | - Panayiotis J Papagelopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece.,First Department of Orthopaedic Surgery, 'Attikon' University General Hospital, Chaidari, Attica, Greece
| |
Collapse
|
9
|
Almoajil H, Wilson N, Theologis T, Hopewell S, Toye F, Dawes H. Outcome domains and measures after lower limb orthopaedic surgery for ambulant children with cerebral palsy: an updated scoping review. Dev Med Child Neurol 2020; 62:1138-1146. [PMID: 32567044 DOI: 10.1111/dmcn.14599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022]
Abstract
AIM To determine the reported outcome domains and measures used to assess lower limb orthopaedic surgery of ambulant children and young people with cerebral palsy (CP) and map these outcomes to the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY) framework. METHOD This updated scoping review included studies published between January 2016 and July 2019 in five databases: MEDLINE, PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials. Studies were included if participants were ambulant individuals with CP aged between 0 and 20 years who had undergone lower limb orthopaedic surgery. Health outcome domains and measures were identified and classified using the ICF-CY framework. RESULTS Forty-four eligible studies were identified with a total of 40 different outcome domains recorded. Among eligible studies, 44 (100%) measured body function and structural impairment and seven (16%) measured activity limitation and participation restriction. The most frequently reported outcome was gait pattern (n=37, 84%). Few studies reported adverse effects of surgery (n=13, 30%). Twenty-nine different outcome measures were identified. Patient-reported outcomes measures were used in 10 studies (23%). INTERPRETATION The review highlights a heterogeneity in the reported outcome domains and measures used in CP studies. The majority of the reported outcomes focus on the ICF-CY domain of body function and structure. The review also highlights a notable shift towards patient-reported outcomes in recent years. Development of a core outcome set for lower limb orthopaedic surgery would guide researchers to use more consistent and complete measurement sets.
Collapse
Affiliation(s)
- Hajar Almoajil
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Department of Physical Therapy, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nichola Wilson
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tim Theologis
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Paediatric Orthopaedic Surgery, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sally Hopewell
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francine Toye
- Physiotherapy Research Unite, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Helen Dawes
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| |
Collapse
|
10
|
Sees JP, Truong WH, Novacheck TF, Miller F, Georgiadis AG. What's New in the Orthopaedic Treatment of Ambulatory Children With Cerebral Palsy Using Gait Analysis. J Pediatr Orthop 2020; 40:e498-503. [PMID: 32501922 DOI: 10.1097/BPO.0000000000001461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limb deformities in ambulatory children with cerebral palsy (CP) are common. The natural history of lower extremity deformities is variable and the impact on gait is managed with many treatment modalities. Effective interventions must consider the underlying pathophysiology, patient-specific goals, and incorporate objective outcome assessment. Evaluation and treatment include observation, tone management multilevel orthopaedic surgery to address muscle contractures and bony deformities, and the use of gait analysis for preoperative and postoperative assessment. METHODS A PubMed search of the orthopaedic literature for studies published between January 2016 and February 2019 was performed. Eligible abstracts included the use of 3-dimensional instrumented gait analysis in the evaluation and treatment of the lower extremities in ambulatory children with CP. Seven hundred twenty abstracts were reviewed, with 84 papers identified as eligible, of which 45 full manuscripts were included for detailed review. RESULTS The review summarized recent advances regarding the treatment of torsional alignment, knee deformities and clinical gait evaluation with visual assessment tools compared with instrumented gait analysis. CONCLUSIONS Gait analysis of ambulatory children with CP remains essential to evaluation and surgical decision-making. Promising results have been reported with the goal of maintaining or reaching a higher level of function and increased endurance. LEVEL OF EVIDENCE Level IV-literature review.
Collapse
|
11
|
Abstract
Purpose. To find risk factors for soccer-related musculoskeletal injuries among elite, adolescent male soccer players. Methods. Prior to the season, various physical, clinical, and functional measurements were taken. One season was used as an injury surveillance period. Then, after the season, measures of potential risk factors were compared between (1) those players who sustained musculoskeletal injuries and (2) those who remained injury free. Results. Among 61 players, 37.7% (23/61) sustained soccer-related musculoskeletal injuries. After adjusting for covariates in a logistic regression model, presence of previous hip and low back injury (adjusted odds ratio [aOR] = 8.93, P = .046) and Functional Movement Screen (FMS) scores (aOR = 1.92, P = .022) were independently associated with musculoskeletal injures. Conclusion. Elite, adolescent male soccer players with a history of hip and back injury are at greater risk of sustaining a soccer-related musculoskeletal injury. In addition, our study indicated greater risk of sustaining a future soccer-related injury as FMS scores increase.
Collapse
Affiliation(s)
- Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Faculty of Sport Sciences, Waseda University, Tokyo, Japan
| | | | | | - Jennifer M Morse
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Dennis R Borg
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
12
|
O’Sullivan R, Leonard J, Quinn A, Kiernan D. The short-term effects of selective dorsal rhizotomy on gait compared to matched cerebral palsy control groups. PLoS One 2019; 14:e0220119. [PMID: 31361785 PMCID: PMC6667201 DOI: 10.1371/journal.pone.0220119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/09/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives To examine the short-term effects of selective dorsal rhizotomy (SDR) ± soft-tissue surgery on gait in cerebral palsy (CP) compared to matched controls with no surgical intervention. Methods Participants had gait analysis before and one year after SDR. Non SDR participants were retrospectively matched for age and all significant gait parameters. The SDR group was further subdivided into those who had concomitant orthopaedic surgery and those who had SDR only. Results The SDR group consisted of 29 participants (mean age 5.8 years at baseline, 7.7 years at follow-up). Of these, 13 had concomitant orthopaedic surgery. The non SDR group consisted of 18 participants (mean age at baseline 6.1 years, 8.1 years at follow-up). SDR ± soft-tissue surgery significantly improved step-lengths, knee flexion at initial contact and mid-stance, ankle dorsiflexion, foot progression and timing of peak knee flexion. None of these improvements in gait were seen without surgical intervention. While more improvements were seen in those who had SDR and orthopaedic surgery, SDR only resulted in improved step-lengths, knee extension, foot progression and timing of peak knee flexion. Conclusions SDR ± soft-tissue surgery results in short-term improvements in gait which are not seen without surgical intervention. While those who had SDR and soft-tissue surgery demonstrated more changes in gait, many improvements were attributable to SDR only.
Collapse
Affiliation(s)
| | - Jane Leonard
- Central Remedial Clinic, Clontarf, Dublin, Ireland
| | - Aoife Quinn
- Central Remedial Clinic, Clontarf, Dublin, Ireland
| | | |
Collapse
|
13
|
Khaje Mozafari J, Pisoudeh K, Gharanizade K, Abolghasemian M. Percutaneous Versus Open Hamstring Lengthening in Spastic Diplegic Cerebral Palsy. Arch Bone Jt Surg 2019; 7:373-378. [PMID: 31448316 PMCID: PMC6686065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/06/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Open hamstring lengthening (oHSL) is commonly performed to decrease knee contracture and improve gait and posture for children with spastic diplegia. Furthermore, percutaneous hamstring lengthening (pHSL) is also gaining popularity as an alternative to the open approach. This study aimed to compare the results of pHSL versus oHSL and to determine the efficacy and safety of the percutaneous approach. METHODS This retrospective included 54 patients (108 knees) with spastic diplegia operated for flexed knee gait with either open or percutaneous HSL. The mean age of the participants at the time of surgery was 10.3±1.7 years (age range: 5-25 years) for the open and 8.5±1.5 years (age range: 7-23 years) for the percutaneous group. Overall, 29 and 25 children were subjected to oHSL and pHSL, respectively. RESULTS The mean durations of follow-up were 19.1 months (range: 12-49 months) and 18.3 months (range: 14-45 months) for oHSL and pHSL groups, respectively. In the open group, the mean of preoperative popliteal angle decreased from 64.3±3.6 to 28.4±4.3 (P<0.001), and in the percutaneous group from 63.8±2.7 to 29.5±2.3 (P<0.001). The obtained results revealed no significant differences between the two approaches leading to a similar improvement among the investigated patients (P=0.83). Although the Gross Motor Function Class Score improved significantly within each group (P<0.001); this improvement was insignificant between the groups (P=0.88). The mean of hospital stay for the percutaneous group was 1.6 days (range:1-3 days) compared to 3.6 days (range: 2-6 days) for the open group, which indicated a significant difference (P=0.001). The mean values of total cost were $333 and $473 in the percutaneous group and open group (P=0.001), respectively. There was no significant difference between the groups regarding the complication rate (P=0.85). CONCLUSION Percutaneous HSL is a safe, easy, rapid, and brief procedure that is as effective as the open technique for children with spastic diplegia in a short period of time. However, it is essential to examine the effects of this approach during longer follow-ups to generalize the findings of the current study.
Collapse
Affiliation(s)
- Javad Khaje Mozafari
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Orthopaedic Department, Shafa hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Karim Pisoudeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Orthopaedic Department, Shafa hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Kave Gharanizade
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Orthopaedic Department, Shafa hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mansour Abolghasemian
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Research performed at Orthopaedic Department, Shafa hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| |
Collapse
|
14
|
Wijesekera MPC, Wilson NC, Trinca D, Holmes G, Bass A, Wright DM, Walton R. Pelvic Tilt Changes After Hamstring Lengthening in Children With Cerebral Palsy. J Pediatr Orthop 2019; 39:e380-5. [PMID: 30649081 DOI: 10.1097/BPO.0000000000001326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Flexion deformity of the knee is a common presentation in children with cerebral palsy with hamstring surgery as an option for addressing this. However, concerns with regard to increased pelvic tilt have been raised. The purpose of this study was to compare preoperative and postoperative pelvic tilt after isolated hamstring lengthening versus combined hamstring lengthening and the influence of Gross Motor Function Classification System (GMFCS) levels on pelvic tilt. METHODS This retrospective study included 46 ambulatory children with cerebral palsy who had had open medial hamstring lengthening (mean age at surgery, 11 y 11 mo; SD, 2 y 11 mo; GMFCS I, 16; GMFCS II 20; GMFCS III 10). Twelve children underwent isolated surgery and 34 children underwent combined surgery. The isolated hamstring procedures could be combined with foot and/or ankle-level surgery, as only the hamstring procedure would affect the pelvic tilt. Combined surgery was defined as hamstring lengthening with other procedures performed at the knee or more proximally. The preoperative and postoperative 3-dimensional gait analysis data were evaluated in this study. RESULTS Both the isolated and combined hamstring lengthening groups showed no significant change in pelvic tilt ([INCREMENT]1.28, P=0.203; [INCREMENT]1.47, P=0.113, respectively). A significant change in pelvic tilt was seen in children functioning at GMFCS III ([INCREMENT]4.66, P=0.009) but not GMFCS I and II ([INCREMENT]0.37, P=0.718; [INCREMENT]0.48, P=0.697). Significant postoperative decreases in the knee flexion angle at initial contact were seen for both isolated ([INCREMENT]5.72, P=0.010) and combined hamstring lengthening ([INCREMENT]10.95, P<0.001). CONCLUSIONS Hamstring lengthening, for the majority of patients, did not lead to a clinically significant change in mean pelvic tilt and improved knee flexion angle at initial contact. Children who functioned at GMFCS level III had an increase in anterior pelvic tilt and caution should be exercised in this group. STUDY DESIGN Level IV evidence-case series.
Collapse
|
15
|
Skoutelis VC, Kanellopoulos A, Vrettos S, Gkrimas G, Kontogeorgakos V. Improving gait and lower-limb muscle strength in children with cerebral palsy following Selective Percutaneous Myofascial Lengthening and functional physiotherapy. NeuroRehabilitation 2019; 43:361-368. [PMID: 30400115 DOI: 10.3233/nre-182468] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Selective Percutaneous Myofascial Lengthening (SPML) is an innovative minimally invasive surgical procedure, using micro incisions often combined with alcohol nerve block, for managing muscle contractures and stiffness in children with cerebral palsy (CP). There is lack of evidence of effects of a combined intervention of SPML and physiotherapy on gait function and muscle strength in CP. OBJECTIVE This study investigated the change in gait function and muscle strength in children with CP who underwent gait laboratory assessment before and after SPML, combined with obturator nerve blocks, and 9-month post-surgical functional physiotherapy. METHODS Ten children with bilateral spastic CP, Gross Motor Function Classification System (GMFCS) level II-IV, age 5-7 years, participated in this study. The Global Gait Graph Deviation Index (Global GGDI) and isometric muscle strength (hand-held dynamometry) were the primary outcome measures. Changes in spatiotemporal gait parameters, gross motor function and GMFCS level were secondarily examined. RESULTS A significant improvement of Global GGDI was found (p < 0.05). The mean strength in hip flexors, extensors and adductors, knee extensors, and ankle dorsiflexors increased significantly (p < 0.05). Children improved significantly their GMFCS level and gross motor capacity (p < 0.05). CONCLUSIONS SPML procedure combined with functional physiotherapy can improve gait function and lower-limb muscle strength.
Collapse
Affiliation(s)
| | | | | | - Georgios Gkrimas
- Gait & Motion Analysis Laboratory, Hellenic Society for Disabled Children (ELEPAP), Athens, Greece
| | - Vasileios Kontogeorgakos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.,First Department of Orthopaedics, 'Attikon' University Hospital, Chaidari, Greece
| |
Collapse
|
16
|
Kelly DM, VanderHave K, Martus JE. What's New in Pediatric Orthopaedics. J Bone Joint Surg Am 2018; 100:348-354. [PMID: 29462042 DOI: 10.2106/jbjs.17.01139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Kelly VanderHave
- Carolinas HealthCare System and Levine Children's Hospital, Charlotte, North Carolina
| | - Jeffrey E Martus
- Vanderbilt Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| |
Collapse
|