Outcomes of Patellar Tendon Imbrication With Distal Femoral Extension Osteotomy for Treatment of Crouch Gait. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Hyer, Lauren C.; Carpenter, Ashley M.; Saraswat, Prabhav; Davids, Jon R.; Westberry, David E.
• Is Part Of: Journal of pediatric orthopaedics. Volume 41:Issue 5(2021)
• Publication Date: 2021-05
• Subjects: patellar tendon imbrication -- crouch gait -- distal femoral extension osteotomy -- patellar tendon advancement -- cerebral palsy -- motion analysis -- gait analysis; Pediatric orthopedics -- Periodicals; 618.927
• DOI: 10.1097/BPO.0000000000001793
• Languages: English
• ISSNs: 0271-6798

Abstract

Abstract : Background: Crouch gait is a frequent gait abnormality observed in children with cerebral palsy. Distal femoral extension osteotomy (DFEO) with the tightening of the extensor mechanism is a common treatment strategy to address the pathologic knee flexion contracture and patella alta. The goal of this study was to review the results of a patellar tendon imbrication (PTI) strategy to address quadriceps insufficiency in the setting of children undergoing DFEO. Methods: After institutional review board approval, all patients with crouch gait treated at a single institution with DFEO and PTI were identified. Clinical, radiographic, and instrumented gait analysis data were analyzed preoperatively and at 1 year following surgery. Results: Twenty-eight patients (54 extremities) with a diagnosis of cerebral palsy and crouch gait were included. Significant improvements were appreciated in the degree of knee flexion contracture, quadriceps strength, knee extensor lag, and popliteal angle ( P <0.01). Knee flexion at initial contact and during mid-stance improved significantly ( P <0.0001), and knee moments in late stance were significantly reduced ( P <0.01). The anterior pelvic tilt, however, significantly increased postoperatively ( P <0.0001). Radiographic improvements were seen in the knee flexion angle and patellar station as assessed by the Koshino Sugimoto Index ( P <0.0001). Four patients (14.2%) developed a recurrence of knee flexion contracture requiring further intervention. Conclusions: PTI is a simplified and safe technique to address quadriceps insufficiency when performing DFEO. The short-term results of patients who underwent DFEO with PTI demonstrated improvements in clinical, radiographic, and gait analysis variables of the knee. Investigating long-term outcomes, comparing techniques, and assessing quality of life measures are important next steps in research. Level of Evidence: Level IV—case series.