A prospective cohort study of the effects of lower extremity orthopaedic surgery on outcome measures in ambulatory children with cerebral palsy.
BACKGROUND
Lower-extremity musculotendinous surgery is standard treatment for ambulatory children with deformities such as joint contractures and bony torsions resulting from cerebral palsy (CP). However, evidence of efficacy is limited to retrospective, uncontrolled studies with small sample sizes focusing on gait variables and clinical examination measures. The aim of this study was to prospectively examine whether lower-extremity musculotendinous surgery in ambulatory children with CP improves impairments and function measured by gait and clinical outcome tools beyond changes found in a concurrent matched control group.


METHODS
Seventy-five children with spastic CP (Gross Motor Function Classification System levels I to III, age 4 to 18 y) that underwent surgery to improve gait were individually matched on the basis of sex, Gross Motor Function Classification System level, and CP subtype to a nonsurgical cohort, minimizing differences in age and Gross Motor Function Measure Dimension E. At baseline and at least 12 months after baseline or surgery, participants completed gait analysis and Gross Motor Function Measure, and parents completed outcome questionnaires. Mean changes at follow-up were compared using analysis of covariance adjusted for baseline differences.


RESULTS
Surgery ranged from single-level soft tissue release to multilevel bony and/or soft tissue procedures. At follow-up, after correcting for baseline differences, Gillette Gait Index, Pediatric Outcomes Data Collection Instrument Expectations, and Pediatric Quality of Life Inventory (PedsQL) Physical Functioning improved significantly for the surgical group compared with the nonsurgical group, which showed minimal change.


CONCLUSIONS
On the basis of a matched concurrent data set, there was significant improvement in function after 1 year for a surgical group compared with a nonsurgical group as measured by the Gillette Gait Index, with few significant changes noted in outcome measures. Changes over 1 year are minimal in the nonsurgical group, supporting the possibility of ethically performing a randomized controlled trial using nonsurgical controls.


METHODS
Therapeutic level 2. Prospective comparative study.
Gorton
George Edwin
GE
Shriners Hospital for Children, Springfield, MA 01104, USA. ggorton@shrinenet.org
Abel
Mark F
MF
Oeffinger
Donna J
DJ
Bagley
Anita
A
Rogers
Sarah P
SP
Damiano
Diane
D
Romness
Mark
M
Tylkowski
Chester
C
D000293:Adolescent; D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000601:surgery; D005360:Fibula / Q000601:surgery; D005684:Gait; D006801:Humans; D007866:Leg / Q000601:surgery*; D007867:Leg Bones / Q000601:surgery*; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery; D019637:Orthopedic Procedures; D010027:Osteotomy; D011446:Prospective Studies; D011788:Quality of Life; D013977:Tibia / Q000601:surgery; D016138:Walking