Changes in gait patterns of adults and adolescents with cerebral palsy following single-event multilevel procedures in stiff knee gait at baseline

The objective of this study was to evaluate outcomes of single-event multilevel orthopaedic procedures including distal rectus femoris transfer (DRFT) performed for adolescents and adults with cerebral palsy (CP) and stiff knee gait (SKG) pattern. Material and methods Twenty patients (mean age, 17.1 ± 2.9 years) with SKG were included in the study. Among them, 16 were classified as GMFCS level II and 4 as GMFCS level III. All patients underwent singleevent multilevel orthopedic procedures including DRFT. Gait analysis was performed preoperatively and at a 1-to-2-year follow-up using Edinburgh Visual Gait Score and 3D analysis. The Gait Profile Score (GPS), peak knee flexion in swing phase, knee range of motion across the gait cycle and the maximum knee flexion angle recorded with the time of occurrence as a percentage of the gait cycle were measured in the patients. Results Comparison of pre- and postoperative measurements showed improvement in peak knee flexion in swing phase and the associated improvement in foot clearance. Improved knee terminal-swing position was found to improve initial foot contact with the supporting surface. Postoperative statistically significant increase in the knee range of motion across the gait cycle could be attributed to both increase in the knee flexion in swing phase and decrease in the knee flexion angle in stance due to correction of a pathological angle of dorsiflexion that necessitated correction of compensatory knee flexion to retain vertical position. Conclusion DRFT has been shown to be effective for correction of disturbed knee kinematics in patients with SKG pattern to allow increase in peak knee flexion in swing phase and overall knee range of motion across the gait cycle. The technique can be advocated as part of single-event multilevel orthopedic procedures to improve integral gait parameters. Excessive ankle dorsiflexion in stance phase resulting from previous triceps surae lengthening surgeries must be accurately addressed with DRFT procedure in order to prevent a greater increase in ankle dorsiflexion and iatrogenic crouch gait.