Article

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
degrees throughout the gait cycle, with an improvement in the knee GVS of 14
degrees (p<0.001). The overall gait pattern improved with a mean decrease in GPS
of 4.6 degrees . 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. LEVEL OF EVIDENCE: Level III.
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Langue : ANGLAIS