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Short-term Hardware Outcomes Following Patellar Tendon Advancement in Pediatric Patients with Crouch Gait. Authors Institutions. Introduction. Cerebral Palsy: motor syndromes - 2° to brain development Crouch gait – spasticity/contracture Hamstring/psoas tightness Lever-arm dysfunction

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Authors Institutions

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  1. Short-term Hardware Outcomes Following Patellar Tendon Advancement in Pediatric Patients with Crouch Gait Authors Institutions

  2. Introduction • Cerebral Palsy: motor syndromes - 2° to brain development • Crouch gait – spasticity/contracture • Hamstring/psoas tightness • Lever-arm dysfunction • Weakness • Impaired balance Kliegman, Robert M., Richard E. Behrman, Hal B. Jenson, and Bonita F. Stanton. Nelson Textbook of Pediatrics. Philadelphia: Saunders, 2007.

  3. Crouch Gait • Body Mechanics • Knee flexion • Hip flexion • Ankle dorsiflexion • Knee and back pain • Quadriceps insufficiency • Patella alta & Elongation of patellar tendon • 2° to achilles tendon lengthening Chambers Eur J Neur 2001 Stout et al. JBJS 2008

  4. Treatment • Gait analysis for evaluation (Pre-op Mov?) • Conservative • Occupational/Physical therapy • Assistive devices • Medical • Muscle relaxants • Benzodiazepines • Botulinum toxin Kliegman, Robert M., Richard E. Behrman, Hal B. Jenson, and Bonita F. Stanton. Nelson Textbook of Pediatrics. Philadelphia: Saunders, 2007.

  5. Surgical Treatment • Procedures typically done • (Get from Halanski) • (Preop and postop x-rays) • (Preop/postop gait analysis)

  6. Crouch Gait

  7. Surgical Treatment • Distal femoral extension osteotomy • Patellar tendon advancement • Patellar insertion freed • Patellar tendon advanced distally along tibia - Cercalage wire from patella to insertion Stabilize new insertion • Combination Stout et al JBJS 2008

  8. Objective • To examine the short-term outcomes of hardware failure following patellar tendon advancement in patients with crouch gait • 2 Hardware types - Cercalage cable - Cercalage wire

  9. Methods • Retrospective cohort study radiographs • Inclusion Criteria • Billing codes: patellar advancement • Helen DeVos Children’s Hospital • 1/1/03 to 11/2/08 • Exclusion criteria • Different procedure performed • Age > 17

  10. Methods • Patient radiographs • Cercalage wire vs. cable • Failure vs. Intact • Patient records • Age at procedure • Time to post-op radiograph • Time to failure • Fisher’s exact test

  11. Radiographs • Cercalage wire • Cercalage cable

  12. Hardware Failure

  13. Results • 16 Patients with • 31 Patellar advancements • Fisher’s exact T-test (p < 0.001)

  14. Discussion • Statistically significant advantage to cables • Shorter follow-up time • Continued observation cables • 1 year follow-up

  15. Conclusion • Cables show better outcomes than wires • 1 year follow-up for recommendations • Possible implications • Decrease failed hardware removal • More rapid mobilization post-op Reference

  16. Future Work • Continue follow-up for > 1 year • Evaluation of long-term hardware outcomes • Evaluation of patellar advancement on growth plate mechanics • Evaluation of gait kinematics Reference

  17. Acknowledgments • Attending • Editor • Statistician • Institution

  18. Questions?

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