Evaluation of infrapatellar tendon plication in spastic cerebral palsy with crouch gait pattern: a pilot study.

Mohamed Tageldeen Mohamed ,Mohamed Elsobky,Ahmed Samir Barakat ,Mostafa H El-Sherbini ,Mohamed Tharwat Hegazy ,Hassan Elbarbary ,Mohamed Abdel‐Mohsen ,Nader M Diab

doi:10.1051/sicotj/2020037

Mohamed Tageldeen Mohamed , Mohamed Elsobky + Show 6 more

Open Access

https://doi.org/10.1051/sicotj/2020037

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Abstract

Objective: In order to substantially improve crouch pattern in cerebral palsy, the existent patella alta needs to be addressed. This pilot study evaluates the effectiveness of a previously described infrapatellar tendon plication for the treatment of patella alta in crouch gait pattern in skeletally immature spastic cerebral palsy patients. Methods: In 10 skeletally immature patients (20 knees) with spastic diplegia and crouch gait, the previously described technique by Joseph et al. for infrapatellar tendon plication was evaluated within the setting of single event multilevel surgery (SEMLS). Outcome measures included knee extension lag, Koshino’s radiological index for patella alta, and the occurrence of complications. Patients were followed-up for a minimum of 12 months. Results: The extensor lag improved and was statistically significant in all cases of the study with no incidence of tibial apophyseal injury at the latest follow-up. Radiographic Koshino index normalized and was maintained all through the follow-up period except in one patient (5%) who was overcorrected. Two patients (4 knees, 20%) showed postoperative knee stiffness due to casting which resolved with physiotherapy within six weeks. One knee (5%) developed a superficial infection which also resolved uneventfully with repeated dressings. Conclusion: The described infra-patellar plication technique in skeletally immature spastic diplegics appears effective, safe, and reproducible.

Highlights

The intrigue association between patella alta and crouch knee gait pattern is founded on several factors including quadriceps weakness or spasticity and hamstring spasticity [1]
In patella alta there is a decreased moment arm of terminal knee extension since the patella rests on the distal femoral shaft rather than on the contoured femoral condyles
This pilot study assesses the effectiveness of infrapatellar tendon plication in patella alta of skeletally immature spastic

Summary

Introduction

The intrigue association between patella alta and crouch knee gait pattern is founded on several factors including quadriceps weakness or spasticity and hamstring spasticity [1]. In patella alta there is a decreased moment arm of terminal knee extension since the patella rests on the distal femoral shaft rather than on the contoured femoral condyles This contributes to a poor moment generation of an already weakened extensor mechanism, resulting in a flexed knee posture and increased tension across the patellofemoral joint which may lead to degenerative changes in this joint [1]. This pilot study assesses the effectiveness of infrapatellar tendon plication in patella alta of skeletally immature spastic

Methods

Results

Conclusion