Evidence of knee extensor dysfunction during sit-to-stand following distal femoral extension osteotomy and patellar tendon advancement in young adults with cerebral palsy: A pilot study

• Published in: Gait & posture Vol. 58; pp. 527 - 532
• Main Authors: Boyer, Elizabeth R., Stout, Jean L., Laine, Jennifer C., Gutknecht, Sarah M., Oliveira, Lucas Henrique, Munger, Meghan E., Schwartz, Michael H., Novacheck, Tom F.
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.10.2017
• Subjects: 5-times sit-to-stand test; Adolescent; Adult; Biomechanical Phenomena; Cerebral Palsy - physiopathology; Cerebral Palsy - surgery; Crouch gait; Distal femoral extension osteotomy; Female; Flexed-knee gait; Gait - physiology; Humans; Knee Joint - physiopathology; Male; Osteotomy - adverse effects; Osteotomy - methods; Patella - surgery; Patella baja; Patellar Ligament - physiopathology; Patellar Ligament - surgery; Patellar tendon advancement; Pilot Projects; Retrospective Studies; Tendon Transfer; Young Adult; Distal femoral extension osteotomy; Patellar tendon advancement; Crouch gait; Flexed-knee gait; 5-times sit-to-stand test; Patella baja
• ISSN: 0966-6362; 1879-2219
• DOI: 10.1016/j.gaitpost.2017.09.018

•People who received a DFEO+PTA performed a sit-to-stand task slower than controls.•People who received a DFEO+PTA absorbed less knee power during sit-to-stand.•Observed patella baja versus normal position reduced knee extensor moment arm by ∼21%.•These clinical data support modeling-predicted adverse effects of patella baja.•Worse gross motor function also adversely affects sit-to-stand performance. A distal femoral extension osteotomy with patellar tendon advancement (DFEO+PTA) is a common treatment for individuals with cerebral palsy (CP) who walk in crouch. Musculoskeletal modeling suggests that the typical patella baja position post-DFEO+PTA may limit one’s abilities to perform sit-to-stand (STS) tasks; however, STS function has not been assessed. Our purpose was to compare how well individuals who received a DFEO+PTA can perform a 5-times STS test (FTSST) eight or more years after surgery compared to their peers who did not receive a DFEO+PTA (non-DFEO+PTA group). Twenty-one participants completed the task (12 DFEO+PTA, 9 non-DFEO+PTA). Three-dimensional kinematics and kinetics were captured. Kinetics were non-dimensionalized to facilitate group comparisons. Non-DFEO+PTA participants performed the FTSST moderately faster than the DFEO+PTA group (median(IQR), 14.6(9.3) seconds vs. 20.3(10.1) seconds, non-parametric effect size ɣ=0.97, p=0.241). Peak negative knee power was larger for the non-DFEO+PTA group (Mean±SD, −0.063±0.025 vs. −0.048± 0.020, Cohen’s d=0.66, p=0.165). A similar but weaker trend was observed for negative hip power (median(IQR) −0.120(0.066) vs. −0.105(0.044), ɣ=0.43, p=0.671). Both groups used their hips approximately twice as much as their knees to perform the task. The functional deficit among DFEO+PTA participants may be due to patella baja decreasing the knee extensor moment arm, which concurs with the modeling prediction. The group differences may also be due to the non-DFEO+PTA group being slightly higher functioning. Future research is warranted to determine if optimizing patella position during a DFEO+PTA may improve unaided STS function without compromising gait improvements.