The main approaches to the knee joint stabilization in patients with cerebral palsy

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Abstract

Objective: to improve the results of surgical correction of flexion contracture of knee joint in patients with cerebral palsy. Material and methods. 196 patients with cerebral palsy aged from 2.5 to 18 years old were examined. In 131 patients aged from 8 to 18 years old we performed lengthening of tibia flexors with posterior capsulotomy and without it, in 4 patients aged from 11 to 16 years old the contracture was corrected after preliminary reduction of muscle tone using lumbar dorsal selective rhizotomy (LDSR). Among 246 operated segments a slight contracture in 23 cases was eliminated only with lengthening of tibia flexors, in the remaining 223 cases in addition after lengthening of tibia flexors the residual contracture was corrected by the method of pre-dosed correction in plaster cast. In 16 segments if there was a severe contracture we performed a posterior capsulotomy of knee joint. Besides, we investigated the dependence of contraction degree from phase-tonic activity of tibia flexors, as well as the influence of LDSR on the possibility to correct flexion contracture in 65 knee joints of patients aged from 2.5 to 16 years old. Results. The high degree of dependence of knee flexion contracture (KFC) from tone increase of tibia muscle flexors (correlation coefficient r p<=0,01 in patients aged from 2.5 to 7 years old is 0,942, 8-16 years old - 0,712). Probably that is why in 65 investigated joints using LDSR the contracture was corrected in the younger age group in 50 %, in elder age group - in 46 % cases after reduction of muscle tone - tibia flexors by 59% and 37%. Taking into consideration the data we worked out the indications for different variants of surgical correction of KFC depending on the degree of its intensity and with account of muscle hypertonia. As a result of the appliance of differentiated approach the contracture was corrected in 91,6 cases. Conclusion. The main causes of knee flexion contracture in patients with cerebral palsy are contractures and muscle imbalance in contiguous segments, predominance of tibia flexor tone and weakness of soleus muscle. Differentiated approach allows correcting contracture in most cases.

About the authors

V. V. Umnov

Turner Scientific and Research Institute for Children’s Orthopedics

Author for correspondence.
Email: umnovvv@gmail.com
Russian Federation

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