The effect of the Majestro-Frost procedure on internal hip rotation during gait in patients with cerebral palsy

• Published in: Gait & posture Vol. 66; pp. 32 - 37
• Main Authors: de Morais Filho, Mauro César, Blumetti, Francesco Camara, Kawamura, Cátia Miyuki, Ferreira, Cássio Luís, Lopes, José Augusto Fernandes, Fujino, Marcelo Hideki, Neves, Daniella Lins
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.10.2018
• Subjects: Adolescent; Biomechanical Phenomena; Cerebral palsy; Cerebral Palsy - physiopathology; Cerebral Palsy - surgery; Child; Female; Gait; Gait - physiology; Gait Analysis - methods; Gait Disorders, Neurologic - physiopathology; Gait Disorders, Neurologic - surgery; Hip Joint - physiopathology; Hip Joint - surgery; Humans; Internal hip rotation; Majestro-Frost procedure; Male; Orthopedic Procedures - adverse effects; Orthopedic Procedures - methods; Range of Motion, Articular - physiology; Retrospective Studies; Soft tissues procedures; Treatment Outcome; Walking - physiology; Young Adult; Internal hip rotation; Cerebral palsy; Soft tissues procedures; Majestro-Frost procedure; Gait
• ISSN: 0966-6362; 1879-2219
• DOI: 10.1016/j.gaitpost.2018.08.014

•First study to analyze the impact of Majestro-Frost procedure at kinematics.•Majestro-Frost procedure reduces internal hip rotation during gait.•Majestro-Frost procedure can produce some asymmetry in coronal plane. Muscle imbalance is related to persistent internal hip rotation (IHR) after femoral derotation osteotomy (FDO) in cerebral palsy (CP). The aim of this study was to evaluate the effect of the Majestro-Frost soft tissue procedure (MFP), which potentially addresses muscle imbalance, on IHR in CP patients during walking. A retrospective study of an existing database (medical records and gait laboratory data) was conducted and a search was performed using the following inclusion criteria: (1) diagnosis of spastic CP, (2) GMFCS levels I-III; (3) mean IHR during stance phase higher than 11° at baseline; (4) individuals who received single event multilevel orthopedic surgery in the lower limbs and had three-dimensional gait analyses (3DGA) before and after the intervention. Patients who underwent a FDO were excluded. Eighty-three individuals were considered for the study and they were divided into two groups: No MFP (45 patients who did not receive a MFP) and MFP (36 patients who underwent a MFP). A full clinical examination and 3DGA, with kinematics calculated according to a standard software procedure (Plugin Gait), were performed before and after the intervention, and the results were compared. The studied groups matched regarding demographic data and GMFCS distribution. The mean follow-up time was more than 20 months on both groups. The increase of clinical external hip rotation (EHR) on physical examination was observed only in the MFP group (from 26.4° to 33°, p = 0.002). During gait analysis, IHR decreased from 21.2° to 4.5° in the MFP group (p < 0.001) and from 16.9° to 7.9° in the No MFP group (p < 0.001). The reduction of IHR during gait was more significant in the MFP group (p = 0.001). In the present study, patients who underwent a MFP showed more reduction of IHR during gait than those which did not undergo a MFP.