Diagnosis and treatment of crouch gait in children with cerebral palsy. Report from the 4th Edition of the Transatlantic Orthopedic Surgery Webinar 2022

Abstract

Introduction. The fourth edition of the Transatlantic Orthopedic Surgery Webinar 2022 took place on December 12th, 2022. The main theme of the webinar was the treatment of crouch gait in children with cerebral palsy (CP). Speakers from Australia, Canada, China, Germany, India, Poland, Spain, Sweden, Turkey, the United Kingdom, and the United States participated. Results. The first general session presented the biomechanics of crouch gait, the function of the hip and knee muscles in children with CP, the principles of prevention and treatment of crouch gait in spastic diplegia, and the natural course and treatment outcomes of CP in adults. The surgical sessions comprehensively presented the surgical techniques for treating crouch gait: percutaneous myofasciotomy in the posterior knee joint, straightening osteotomy of the distal femur in hemiplegia, asymmetric and symmetric diplegia, techniques for shortening and plastically reconstructing the patellar ligament, anterior hemiepiphysiodesis of the distal femur, and transfer of the hamstring muscles to the rectus femoris muscle. The second general session presented postoperative standing and walking rehabilitation protocols and evaluation of treatment outcomes (pain, fatigue, ambulatory activity, motor function, and quality of life). Summary. The most important conclusions from the event were: do not lengthen the Achilles tendon in zone III in crouch gait; laboratory gait analysis is necessary before lengthening the hamstring muscles; hemiepiphysiodesis of the distal femur can be performed when the predicted growth period is less than two years; distal femur osteotomy should be considered during adolescence for knee flexion contracture of 10-40 degrees; treatment possibilities of tendon transfers and myofasciotomies should be remembered, especially in younger patients. The webinar attracted an audience of approximately 1,600 people from 672 centers located in 57 countries. Most participants came from Poland, the United Kingdom, the United States, Norway, Sweden, and India.