Surgically corrected severe crouch gait is stable at 10-year follow-up.

Surgically corrected severe crouch gait is stable at 10-year follow-up.
J RODDA PHD1, R BAKER PHD1,2,3, K GRAHAMMD1,2.
1Gait CCRE Murdoch children’s Research Institute, Royal Children‘s Hospital, Melbourne, VIC;
2The University of Melbourne, VIC;
3LaTrobe University, Melbourne, VIC, Australia.

Background/Objectives: Single event multilevel surgery (SEMLS) for severe crouch gait in spastic diplegia, show improvements at 1 year post SEMLS, which are maintained at 5 years. The natural history of gait in spastic diplegic cerebral palsy is for deterioration. We investigated if improvements can be maintained post –skeletal maturity
Design: Retrospective cohort study.
Participants and setting: Consecutive sample of children with spastic diplegic cerebral palsy (GMFCS level II-III) in severe crouch gait (knee flexion >30 degrees and ankle dorsiflexion>15 degrees throughout stance) who have had SEMLS. The study was conducted in a tertiary paediatric hospital.
Materials/methods: 3D gait analysis undertaken barefoot with usual mobility aids provided the basis for SEMLS prescription and evaluation post SEMLS at 1,5 and 10 years. SEMLS consisted of lengthening contracted muscle- tendon units and rotational osteotomies and bony stabilizations to correct lever arm dysfunction. Post SEMLS, ground reaction ankle foot outhouses were used for 1-2 year individually tailored physiotherapy provided in the community. Parameters assessed wer: functional outcome by mobility scales, technical outcome by kinematics and kinetics. Outcomes were analyzed with linear regression with linear regression with robust standard errors.
Results: Ten subjects fulfilled the inclusion criteria, mean age preop: 12 years (range 8-16), mean follow-up 12 year (8-13) and age 24 years (17-28). SEMLS consisted of: mean seven procedures (range 5-10).crucial improvements at 10 years post were: increased maximum knee extension stance (p<0.001,CI-320,-170), knee excursion (p<0.001,95%CI 100,210),attainment of knee flexor moment midstance (p=0.02,95% CI -0.69 Nm, -0.07Nm), decreased maximum dosiflexion stance (p<0.001,95%CI -0.001 W, 1.2W),The functional Mobility scale over 500 m was improved at 10 years (P=0.03,95% CI 1.1,7.2). There was no statistically significant deterioration in the above parameters between 5 and 10 years.
Conclusions/ Significance: Improvements in gross motor function and gait kinematics post- SEMLS for sever crouch gait are maintained at the knee and ankle, post skeletal maturity. Optimized musculoskeletal alignment by SEMLS delivers a durable correction of severe crouch gait The results support the surgical principles that have been used to correct severe crouch gait. The individual procedures continue to be refined.

 
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