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Recurrence of knee flexion contracture after surgical correction in children with cerebral palsy

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Abstract

Purpose

Knee flexion contracture (FC) and crouch gait are challenging to treat in children with cerebral palsy (CCP), and recurrent knee FC after surgery is a severe complication. The aim was to identify factors associated with recurrent knee FC after surgery.

Methods

The records of 62 CCP (age 10.6±2.6 years) who underwent surgery and were followed for > six months were reviewed. Knee FC was treated by hamstring lengthening, posterior knee capsulotomy, and femoral shortening/extension osteotomy until full extension was obtained. Kaplan-Meier analysis was used to estimate the probability of the correction being maintained. Cox proportional hazard modeling was used to compare parameters between patients with and without recurrent knee FC, with the time to recurrence as the endpoint. Potential confounding factors were included in the multivariate analysis.

Results

In total, the procedure was performed on 122 knees. The average weight-for-age z score was −1.3±1.2. The average follow-up period was 5.4±4.2 years. Knee FC recurrence was observed in 37 knees (30%). The average recurrence-free time was 4.9 years, with most cases of recurrence (33 knees) occurring within six years after surgery. The factors associated with recurrence were age (HR, 1.19) and a required posterior knee capsulotomy procedure (HR, 4.53).

Conclusion

Recurrent knee FC after correction is associated with CCP who are older at the time of operation and when posterior knee capsulotomy is performed. The age at operation should be optimized. The sequence of procedures should be performed only as necessary to minimize the chance of post-operative muscle weakness and recurrence.

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Author information

Authors and Affiliations

  1. School of Medicine, Mae Fah Luang University, Muang District, Chiang Rai, 57100, Thailand

    Supitchakarn Cheewasukanon

  2. Department of Orthopaedics, King Chulalongkorn Memorial hospital, Thai Red Cross society, Bangkok, 10330, Thailand

    Phatcharapa Osateerakun

  3. Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

    Noppachart Limpaphayom

  4. Excellence center for gait and motion, King Chulalongkorn Memorial hospital, Thai Red Cross society, Bangkok, 10330, Thailand

    Noppachart Limpaphayom

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  1. Supitchakarn Cheewasukanon
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  3. Noppachart Limpaphayom
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Supitchakarn Cheewasukanon, Phatcharapa Osateerakun, and Noppachart Limpaphayom. The first draft of the manuscript was written by Supitchakarn Cheewasukanon and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Noppachart Limpaphayom.

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Ethics approval

All procedures involving human participants were in accordance with the ethical standards of the Institutional Review Board of Chulalongkorn University (COA 855/2016) and with the 1964 Declaration of Helsinki and its later amendments.

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No formal consent was required for the retrospective study per the rules set by the institutional review board.

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The authors declare no competing interests.

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Cheewasukanon, S., Osateerakun, P. & Limpaphayom, N. Recurrence of knee flexion contracture after surgical correction in children with cerebral palsy. International Orthopaedics (SICOT) 45, 1523–1530 (2021). https://doi.org/10.1007/s00264-021-05035-z

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  • DOI: https://doi.org/10.1007/s00264-021-05035-z

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