title: Distal femoral extension and shortening osteotomy as a part of multilevel surgery in children with cerebral palsy.
abstract: BACKGROUND
  There are several reports describing an increase in anterior pelvic tilt after hamstring lengthening in children with cerebral palsy (CP). Distal femoral extension and shortening osteotomy (DFESO) is an alternative treatment for correction of flexed knee gait, but investigations analyzing outcome and influence on adjacent joint are few in the literature. The purpose of this study was to analyze the influence of DFESO on knee and pelvis in children with CP. Furthermore, it was of interest if an additional patellar tendon advancement (PA) influences outcome.
  
  
  METHODS
  In this retrospective study, 31 limbs of 22 children (GMFCS I-III; mean age: 12.1±3.1 years), who received DFESO were included and kinematic parameters (knee, pelvis) measured by 3-D-gait analysis were compared before and at least 1 year after surgery (mean follow-up period: 15.6 months).
  
  
  RESULTS
  After surgery, during stance phase minimum knee flexion improved significantly by 20.5° (P<0.001) and mean anterior pelvic tilt increased by 4.0 degrees (P=0.045). In 16 limbs, the postoperative increase in maximum anterior pelvic tilt was more than 5°. Limbs who received an additional PA showed the biggest increase in anterior pelvic tilt.
  
  
  CONCLUSIONS
  DFESO is an effective method for correction of flexed knee gait in children with CP. Furthermore, the results of this study indicate that DFESO may lead to an increase in anterior pelvic tilt, which may lead to a recurrence of flexed knee gait. In this context, PA seemed to aggravate the effect on the pelvis.
authors.affiliation: Department of Orthopedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany. Matthias.klotz@med.uni-heidelberg.de.
authors.forename: Matthias C M
authors.initials: MCM
authors.lastname: Klotz
authors.affiliation: Department of Orthopedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
authors.forename: Klemens
authors.initials: K
authors.lastname: Hirsch
authors.affiliation: Department of Orthopedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Heitzmann
authors.affiliation: Department of Orthopedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Maier
authors.affiliation: Department of Orthopedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Hagmann
authors.affiliation: Department of Orthopedic and Trauma Surgery, Heidelberg University Clinics, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Dreher
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D001852:Bone Lengthening / Q000379:methods*; D002370:Casts, Surgical; D002547:Cerebral Palsy / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000601:surgery*; D005858:Germany; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
keywords: cerebral palsy; femoral extension osteotomy; motion analysis