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SUPRA CONDYLAR FEMORAL EXTENSION OSTEOTOMY WITH PATELLAR TENDON ADVANCEMENT TO TREAT FIXED KNEE FLEXION DEFORMITY IN CROUCHING AMBULATORY ADOLESCENTS WITH CEREBRAL PALSY

Background: Ambulatory cerebral palsy (CP) patients present with different gait patterns because of muscular spasticity and contractures and subsequent limited range of motion leading to loss of their functional abilities. Crouch gait is one of the most common gait pattern in ambulatory children with CP. Aim of the work: The purpose of this study is to evaluate the results of supra condylar femoral extension osteotomy (SCFEO) and patellar tendon advancement (PTA) in the treatment of fixed knee flexion deformity (FKFD) in patients with spastic ambulatory cerebral palsy (CP) to achieve full knee extension and restore an appropriate relationship between quadriceps length and tension in order to maintain knee extension during the stance phase of gait to correct the crouch gait. Patient and Methods: This prospective case series study was done on 20 patients (37 knees); 12 males and 8 females, who had spastic or mixed (mainly spastic) CP and walked with a crouch gait, and who underwent combined SCFEO and PTA along with the context of single event multi-level surgery. Results: The mean Fixed Knee Flexion Angle (FKFA) improved from 24.25o ±11.86o to be 2.25o± 2.25o. The mean knee extension lag improved from 15.8o±5.68o to be 4.2o±1.31o. The mean Gross Motor Function Measurement (GMFM) improved from 53.3 to be 69.1. The mean Koshino Index (KI) improved from 1.54±0.29 to be 1.14±0.12.Conclusion: For crouching adolescents there are 4 questions must be answered: Frist, differentiate between isolated myogenic flexion deformity and combined myogenic-arthrogenic knee flexion deformity. Second, assess isolated myogenic flexion deformity due to hamstring shortening by unilateral popliteal angle test. Third, differentiate between apparent and true hamstring shortening by popliteal shift test; apparent functional hamstring shortening and hamstring lengthening is not indicated. Forth, if the unilateral popliteal angle is positive with negative popliteal shift test, true hamstring shortening is found.