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Introduction There are not enough published studies on the impact of early isolated triceps lengthening operations in hemiparesis on the state of motor characteristics and on the development of orthopedic complications in children with GMFCS II. Purpose Аnalyze motor locomotion in children with spastic hemiplegia who had not previously been operated on and those who had undergone isolated surgical lengthening of the triceps at an early age. Material and methods Four groups of children with spastic hemiplegia according to Rodda et Graham types: I) type 2a gait (4 children), II) type 3 (3 children), III) type 4 (7 children), IV) type 4 with previous triceps lengthening (9 children). Results The features revealed in gait types 2a, 3 and 4 in the sagittal plane correspond to the characteristic and previously described features. In all groups, asymmetric rotational movements of the pelvis and tilt asymmetry in the frontal plane were observed. In the group of early isolated tricep lengthening, a decrease in the moment of force by pushing with the foot at the end of the single-support phase was revealed, in combination with an increase in the moment of forces of knee joint extension in the single-support phase. Discussion Early isolated triceps lengthening that weakens its function leads to a compensatory increase in the work of the knee extensors which is similar to the mechanism to of iatrogenic crouch gait, but does not result in a complete loss of walking function in the conditions of a contralateral healthy limb. Conclusions Movement pathology is present in all three measurement planes in gait types 2a, 3, 4 according to the Rodda et Graham classification. The most pronounced deviations were found in gait type 3. The rotational turn of the pelvis is an initially compensatory mechanism due to intratorsion femur deformity. Isolated triceps lengthening surgeries performed at an early age lead to reduced plantar push strength, increased compensatory work of the knee extensors, and probably do not prevent the orthopedic pathology found in Rodda et Graham's gait type 4.

Introduction Spastic hemiplegia (a unilateral neurological disorder) is encountered more often in full-term infants. In most cases, the cause of the condition is intrauterine or perinatal stroke. Children with hemiparetic forms maintain cognitive and functional capabilities in combination with the ability to move independently. Among other forms of cerebral palsy, hemiparetic spastic forms range from 10.4 to 15.3 %. Types with mild motor impairments predominate according to the Gross Motor Function Classification System: 87.8 % are level I GMFCS, 7.1 % are level II GMFCS. The purpose of the work was to summarize information on the use of orthopaedic interventions for hemiparetic forms of cerebral palsy, both from the point of view of their planning and completeness of correction of anatomical disorders including lower limb length discrepancy, and assessment of functional results based on gait analysis. Materials and methods The search for publications was carried out in open electronic sources of medical literature PubMed, eLIBRARY, Scopus, Elsevier, Springer, Research Gate with a search depth of 20 years (2002–2022). The following inclusion criteria were used: systematic reviews of the literature, review articles, cohort studies on the topic of multilevel interventions for hemiparetic types of cerebral palsy. Results and discussion Lower limb length discrepancy of 1 cm or more affects the kinematics of the affected and intact contralateral limb. The unaffected limb is characterized by a compensatory flexion in the hip and knee joints and excessive dorsal flexion in the stance phase. On the affected side, the contribution of shortening to the development of pathological kinematics of the pelvis and spine is especially important. There is a high probability of equinus contracture after surgical correction due to unresolved discrepancy in the length of the lower extremities. Methods for correcting length discrepancy are conservative (compensation with shoes), and surgical lengthening of the lower leg, epiphyseodesis of the contralateral limb, shortening of the contralateral limb. There is no opinion in the literature about the preference of this or that method, and on the necessary magnitude of limb length correction. Conclusion The assessment of limb length discrepancy and contribution of this orthopaedic component to systemic movement disorders in spastic hemiparesis is based on computed tomography or magnetic resonance imaging, as well as on computer gait analysis. In the literature, the issue of limb length correction is considered separately from the complex of other orthopaedic interventions, while the features of correction with regard to spontaneous growth potential or after growth completion have not been defined. The advantage of equalizing the limb length in children with temporary epiphyseodesis over distraction osteogenesis is only supposed. There is not enough data on the effect of the limb length correction magnitude in patients with spastic hemiplegia on the parameters of computer gait analysis.

Introduction The purpose of this cross-sectional study was anamnestic evaluation of the treatment performed in patients with GMFCS levels I, II, III spastic cerebral palsy and to assess their motor status, quality of life and anatomical disorders in the lower extremities in the age range from 17 to18.5 years. Material and methods A cross-sectional study was conducted in patients with spastic types of cerebral palsy at the age of 17‑18.5 years. The completeness and consistency of previous treatment (according to medical documentation), motor abilities, quality of life, radiographic anatomy of the lower extremities were studied. Results We selected 73 patients meeting the inclusion criteria out of 201 cases. Insufficient systematic implementation of complex therapeutic measures was revealed, which was reflected in a high rate of orthopedic interventions (93.1 %). Fibromyotomies, triceps lengthening surgeries performed at an early age (6-7 years) contribute to the development of an iatrogenic crouch gait pattern, a decrease in motor abilities and quality of life by the age of 17-18 years. The probability of maintaining a positive result and improving motor ability by the end of the childhood period is significantly higher in the subgroup of multilevel orthopedic interventions than in patients after fibromyotomies or who did not undergo orthopedic treatment; the differences are significant as the chi-square test for binary samples shows (p = 0.012). Conclusions The severity of impairment of motor abilities, quality of life, incidence of the crouch gait pattern in patients with spastic types of cerebral palsy are close between subgroups at the time of transition to adult medical and diagnostic institutions. The quality of life and motor status after multi-level intervention improves and remains stable by the end of the childhood. Early surgical interventions for lengthening the triceps, fibromyotomy reduce motor potential in the long term, cause the development of the iatrogenic crouch gait pattern, and decrease the quality of life of adolescents with mild neurological disorders.

The aim of this prospective study of a continuous cohort was to investigate anatomical and functional disorders, as well as their combination with manifestations of pathological changes in the articular cartilage of the knee joint in patients with cerebral palsy and a gait pattern classified as crouch gait. Materials and methods The study cohort consisted of 24 patients (20 men and 4 women) with cerebral palsy who had completed natural long bone growth (ages 16 to 42 years). Clinical, X-ray data, results of magnetic resonance imaging, computer analysis of gait, as well as visual assessment of articular cartilage according to Outerbridge were studied in two groups of patients: with natural development of crouch gait (group 1) and with iatrogenic crouch gait (group 2). Results According to the KSS questionnaire, in group 1, four patients (28.6 %) had a satisfactory function of the knee joint, and 10 patients (71.4 %) had poor function. Pain in the knee joint was reported by 12 patients (85.7 %). In the second group, two patients (20 %) had a satisfactory function, and the remaining eight (80 %) a poor one; pain syndrome was reported in 8 cases (80 %). Local articular cartilage defects were found in 6 out of 14 examined patients (42.9 %) in group 1 and in 6 out of 10 examined patients (60 %) in group 2. More pronounced efforts and high energy intensity of walking were found in patients with iatrogenic crouch gait: a more significant moment of force acting on flexion in the knee joint at initial contact, as well as a more pronounced pelvic tilt, combined with significant energy requirements to overcome the maximum flexion and extension moments in the hip joints. For the group of iatrogenic crouch gait, additional factors were found that predispose to pain and arthrosis of the knee joint: stiff knee gait (“frozen knee”), the shift of the generated energy towards the knee and hip joints. Conclusions The crouch gait pattern is heterogeneous in terms of the mechanisms, radiological features of foot deformities, and parameters of computer analysis of gait. An increase in power generation at the level of the hip joints is a common phenomenon in crouch gait, but with the natural development of this gait pattern, a large degree of power generation is also preserved at the level of the ankle joint, while in iatrogenic crouch gait, a decrease in the power generation of the ankle joint and, as a result, the developed increased power at the level of the knee joint contributes to the progression of arthritic degenerative changes. Damage to the articular surfaces of the knee joint is a manifestation of early arthritic changes and requires correction along with the standard elements of surgical intervention in the crouch gait pattern.

Introduction Improving the quality of care has led to an increase in the life expectancy of patients with cerebral palsy and in the number of adult patients suffering from cerebral palsy. However, functional motor limitations aggravate after their physiological growth completion and the risk of pain increases. The aim of this work was to study the literature on the problem of surgical orthopedic treatment in adolescents and adults with cerebral palsy belonging to GMFCS levels I-IV of motor disorders as well as to make a preliminary analysis of the surgical orthopedic treatment performed in this category of patients at our institution. Materials and methods The results of multi-level single-event interventions were studied in 165 patients older than 16 years. The sample for analysis included cases that met the following criteria: age of 16 years and older, spastic types of cerebral palsy, GMFCS levels I–IV. In addition, some patients underwent botulinum therapy during the stages of surgical treatment. Results The maximum functional effect was manifested 12–24 months after the surgery if proper early and subsequent rehabilitation was provided. According to the Gillette Functional Assessment Questionaire, motor abilities improved in 81.3 %. Multilevel interventions included 2.3–3.5 elements on average during one surgical session. Current literature postulates the implementation of multi-level single-event interventions and indications for surgery and follow-up control are studied at a motion analysis laboratory. Conclusion Multi-level orthopedic interventions are indicated for patients who have completed physiological growth. Techniques of such interventions should provide early functional activity. Surgical orthopedic treatment in adult patients with cerebral palsy should be performed by the staff and at an institution that specialize in neuro-orthopedics