title: Flexed-knee gait in children with cerebral palsy: a 10-year follow-up study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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)]. 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA ; Department of Orthopaedics, Children's Hospital of Brabois, Nancy, France ; Department of Orthopaedics, Henri Poincaré University, Nancy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Haumont
authors.affiliation: Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Church
authors.affiliation: Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
authors.forename: Shaun
authors.initials: S
authors.lastname: Hager
authors.affiliation: Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
authors.forename: Maria Julia
authors.initials: MJ
authors.lastname: Cornes
authors.affiliation: Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
authors.forename: Dijana
authors.initials: D
authors.lastname: Poljak
authors.affiliation: Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA ; Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Lennon
authors.affiliation: Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
authors.forename: John
authors.initials: J
authors.lastname: Henley
authors.affiliation: Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
authors.forename: Daveda
authors.initials: D
authors.lastname: Taylor
authors.affiliation: Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Niiler
authors.affiliation: Gait Analysis Laboratory, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
authors.forename: Freeman
authors.initials: F
authors.lastname: Miller
keywords: Cerebral palsy; Flexed-knee gait; Gait analysis; Motion analysis