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Patellar tendon shortening surgery restores the knee extensor mechanism in flexed knee gait in children with cerebral palsy

Greaves, H, Wright, D, Eleuteri, A, Ray, E, Pinzone, O, Bass, A, Walton, R and Barton, G (2024) Patellar tendon shortening surgery restores the knee extensor mechanism in flexed knee gait in children with cerebral palsy. Journal of Orthopaedic Science. ISSN 0949-2658

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Abstract

Background This study evaluated a patellar tendon shortening (PTS) surgical procedure that uses an overlapping repair combined with an additional Tycron non-absorbable suture to support the shortening in children with Cerebral Palsy (CP). This study aimed to outline this surgical technique and to evaluate its effectiveness in restoring the knee extensor mechanism. Methods The sagittal plane lower limb kinematics, peak knee extensor moment, gait deviation index (GDI), localised movement deviation profile (MDP), temporospatial parameters, passive knee extension ROM, quadriceps lag, and knee extensor strength were calculated pre- and postoperatively. To determine significant differences a robust linear regression model with high breakdown point and high efficiency was fitted to the data.Results In this retrospective cohort study, a total of 41 patients with CP who were treated with unilateral or bilateral PTS in isolation or as part of single event multilevel surgery (SEMLS), with a mean age of 11.1 years were included. The knee extension angle improved at initial contact (p < 0.0001), and during stance phase (p < 0.0001). The peak internal knee extensor moment decreased during early (p = 0.0014) and late stance phase (p < 0.0001). The quadriceps lag decreased (p < 0.0001) and knee extensor strength increased (p < 0.0001). The GDI improved (p < 0.0001), as well as the localised MDP for sagittal angles (p < 0.0001) and moments (p = 0.0001). Walking speed (p = 1.0) remained unchanged, but the cadence decreased (p = 0.024) and step length increased (p = 0.0001). Conclusions The knee extension angle and moment during stance phase improved significantly. The children with CP in this study showed improvements in knee extensor strength and quadriceps lag. Thereby it can be concluded that the PTS procedure was able to restore the knee extensor mechanism effectively.

Item Type: Article
Uncontrolled Keywords: 0903 Biomedical Engineering; 1103 Clinical Sciences; Orthopedics
Subjects: R Medicine > RD Surgery
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions: Sport & Exercise Sciences
Publisher: Elsevier BV
SWORD Depositor: A Symplectic
Date Deposited: 24 Jan 2024 14:46
Last Modified: 24 Jan 2024 14:46
DOI or ID number: 10.1016/j.jos.2024.01.004
URI: https://researchonline.ljmu.ac.uk/id/eprint/22437
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