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Treatment of patellar instability in children and adolescents with cerebral palsy
Author(s) -
R BYRNE,
T PICKAR,
Z BLOOM,
H MATSUMOTO,
J DUTKOWSKY
Publication year - 2016
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.06_13225
Subject(s) - cerebral palsy , physical medicine and rehabilitation , medicine , physical therapy , pediatrics , psychology
included: (1) IHR, (2) contralateral pelvic drop, and (3) ipsilateral trunk lean. Study Design: Descriptive. Study Participants & Setting: Our database was queried retrospectively to identify patients with CP and excessive AV (≥50°). Patients with di-, tri-, or quadriplegic CP were included. Any barefoot gait analysis performed prior to a femoral derotation osteotomy was included (3091 limbs). Materials/Methods: Mean hip rotation, pelvic obliquity, and trunk obliquity during stance were measured. Abnormal kinematics were those exceeding 1 standard deviation of typically developing peers. Trunk data were only available for a subset of patients. Results: The prevalence of excessive AV was 49.8%. Patients with excessive AV walked with the following gait characteristics: 60% IHR, 36% neutral hip rotation (HR), 4% external HR, 41% neutral pelvis, 34% ipsilateral pelvic drop, 25% contralateral pelvic drop, 45% neutral trunk, 32% ipsilateral trunk lean, and 23% contralateral trunk lean. Interestingly, ipsilateral rather than contralateral pelvic drop was more common. Conclusions/Significance: In conclusion, the majority of patients with ≥50° AV compensated with their hip, pelvis, or trunk. However, 7% showed no compensation and up to 23% compensated in a manner that would exacerbate functional abductor weakness. The scarcity of contralateral pelvic drop and ipsilateral trunk lean challenges the notion of pervasive weakness causing these gait abnormalities. Additionally, other priorities (e.g., toe clearance) may be the culprit of their gait abnormalities. Future work should investigate what characteristics of these subgroups are driving these gait compensations and if they have differential outcomes to femoral derotation surgery and/or risk for recurring internal hip rotation.