Flexed-knee gait in children with cerebral palsy: A 10-year follow-up study

Thierry Haumont,Chris Church,Nancy Lennon,Daveda Taylor,John Henley,Maria Julia Cornes,Freeman Miller,Tim Niiler,Dijana Poljak,Shaun Hager

doi:10.1007/s11832-013-0505-8

Abstract

While several studies have evaluated the short-term effectiveness of conservative and surgical treatment of flexed-knee gait in children with cerebral palsy (CP), few have explored the long-term outcomes using gait analysis. The purpose of this study was to examine, through gait analysis, the 10-year outcomes of flexed-knee gait in children with CP. Ninety-seven children with spastic CP who walked with a flexed-knee gait underwent two gait evaluations [age 6.1±2.1 and 16.2±2.3years, Gross Motor Function Classification System (GMFCS) I (12), II (45), III (37), IV (3)]. Limbs with knee flexion at initial contact >15° were considered walking with a flexed-knee gait and were included in the study (n=185). Kinematic data were collected using an eight-camera motion analysis system (Motion Analysis, Santa Rosa, CA). Surgical and therapeutic interventions were not controlled. A comparison between the two gait studies showed an overall improvement in gait at 10 years follow-up. Significant improvements were seen in knee flexion at initial contact, Gait Deviation Index (GDI), Gross Motor Function Measure (GMFM), and gait speed (P<0.01 for all). Outcome was also evaluated based on the severity of flexed-knee gait at the initial visit, with functional skills and overall gait (GDI) improving in all groups (P<0.01 for all). The group with a severe flexed-knee gait exhibited the most improvement, while subjects with a mild flexed-knee improved the least. Children at a specialty hospital whose orthopedic care included gait analysis and multi-level surgery showed improvement of flexed-knee gait and gross motor function over a 10-year course, regardless of the initial severity.

Highlights

Cerebral palsy (CP) is the most common movement disorder in children [1, 2], and flexed-knee gait, which is defined by abnormally high knee flexion, is the most common pattern of gait deformity in the cerebral palsy (CP) population [1, 3,4,5,6,7,8]
Ninety-seven children with spastic CP who walked with a flexed-knee gait underwent two gait evaluations [age 6.1 ± 2.1 and 16.2 ± 2.3 years, Gross Motor Function Classification System (GMFCS) I (12), II (45), III (37), IV (3)]
Significant improvements were seen in knee flexion at initial contact, Gait Deviation Index (GDI), Gross Motor Function Measure (GMFM), and gait speed (P \ 0.01 for all)

Summary

Introduction

Cerebral palsy (CP) is the most common movement disorder in children [1, 2], and flexed-knee gait, which is defined by abnormally high knee flexion, is the most common pattern of gait deformity in the CP population [1, 3,4,5,6,7,8]. The evolution of flexed-knee gait often includes knee pain (resulting from apophysitis of the distal pole of the patella and tibial tubercle), increasing torsional malalignment of the lower extremity, increasing foot pain, posterior knee capsule contracture, and progressive loss of gait function during adolescent growth [1, 3, 4, 14]. This evolution is a probable cause of loss of ambulation in severe cases [14].

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