title: Patellar tendon shortening for flexed knee gait in spastic diplegia.
abstract: We evaluated the outcome of three different approaches to the management of flexed knee gait patients with spastic diplegia. The three surgical procedures were patellar tendon shortening (PTS), PTS combined with rotational osteotomies of the femur and/or tibia, and PTS combined with supracondylar extension osteotomy (SEO) of the distal femur. The primary outcome measure was gait kinematics. The knee gait variable score (GVS) and the gait profile score (GPS) were derived from gait kinematics. 24 patients (16 male and 8 female), mean age 16.1 years (SD 5.8 years), who had surgery between 2002 and 2008, were followed for a mean of 22 months. Knee extension during gait improved by a mean of 20° throughout the gait cycle, with an improvement in the knee GVS of 14° (p<0.001). The overall gait pattern improved with a mean decrease in GPS of 4.6°. Correction of patella alta was demonstrated by an improvement in the Koshino index from 1.34 pre-operatively to 1.10 post-operatively (p<0.001). Knee and gait kinematics, physical examination measures and Koshino Index improved in all three surgical groups, suggesting that a tailored approach to the correction of flexed knee gait in spastic diplegia is both feasible and appropriate.
  
  
  METHODS
  Level III.
authors.affiliation: Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland. Electronic address: robsossai@yahoo.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Sossai
authors.affiliation: Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland; Orthopaedic Department, University Hospital Basle, Switzerland; Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vavken
authors.affiliation: Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland.
authors.forename: Reinald
authors.initials: R
authors.lastname: Brunner
authors.affiliation: Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland.
authors.forename: Carlo
authors.initials: C
authors.lastname: Camathias
authors.affiliation: Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: H Kerr
authors.initials: HK
authors.lastname: Graham
authors.affiliation: Pediatric Orthopaedic Department, University Children's Hospital, UKBB, Basle, Switzerland; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: Erich
authors.initials: E
authors.lastname: Rutz
mesh_terms: D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D005260:Female; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D010329:Patella / Q000601:surgery; D017847:Patellar Ligament / Q000601:surgery*; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cerebral palsy; Crouch gait; Gait kinematics; Single event multilevel surgery