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Topic:

Cerebral Palsy

Issue:

Knee

Category:

Neuromuscular

Title:

Anterior Distal Femoral Hemiepiphysiodesis Does Not Change Pelvic Tilt in Children With Cerebral Palsy

Author:

Hanson, Alison M. MSPT; Wren, Tishya A.L. PhD; Rethlefsen, Susan A. PT, DPT; Ciccodicola, Eva PT, DPT; Rubel, Boris BS; Kay, Robert M. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

February 2024

Reference:

44(2): p 76-81, DOI: 10.1097/BPO.0000000000002568

Level Of Evidence:

III

# of Patients:

34

Study Type:

Retrospective comparative study

Location:

Not specified

Summary:

The study investigates whether anterior distal femoral hemiepiphysiodesis (ADFH), used for flexed knee gait and knee flexion deformities in children with cerebral palsy, increases anterior pelvic tilt. It was hypothesized that ADFH, especially when combined with hamstring lengthening (HSL), would cause an increase in pelvic tilt. However, the results showed no significant increase in pelvic tilt after ADFH, particularly in patients without concurrent hamstring lengthening.

Methods:

The change in pelvic tilt across the gait cycle was analyzed. Linear mixed models compared pelvic tilt changes with clinical and gait parameters. Pearson correlation was used to examine the relationship between pelvic tilt and other variables.

Exclusions:

Not specified

Results:

Overall, anterior pelvic tilt increased by 4.4 degrees after ADFH (P = 0.02). Significant increase in pelvic tilt (11.1 degrees) occurred only in the group with concurrent hamstring lengthening (P < 0.001). Minimum knee flexion decreased by 19.1 degrees (P < 0.001), and dynamic hamstring lengths increased significantly (P < 0.001). Pelvic tilt increased more significantly in Gross Motor Function Classification System (GMFCS) levels III-IV (5.9 degrees, P = 0.02), but not in levels I-II (2.5 degrees, P = 0.37). Change in pelvic tilt correlated with changes in maximum dynamic hamstring lengths (r = 0.87, P < 0.0001) and minimum knee flexion in stance (r = −0.71, P < 0.0001).

Conclusions:

Anterior distal femoral hemiepiphysiodesis alone did not result in significant changes to pelvic tilt. When combined with hamstring lengthening, pelvic tilt increased significantly. Surgeons should consider ADFH for flexed knee deformities in patients with cerebral palsy who have long dynamically modeled hamstrings and want to maintain pelvic tilt.

Relevance:

Limitations:

Perspective:

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