Presentation on theme: "Short-term Hardware Outcomes Following Patellar Tendon Advancement in Pediatric Patients with Crouch Gait AuthorsInstitutions."— Presentation transcript:
Short-term Hardware Outcomes Following Patellar Tendon Advancement in Pediatric Patients with Crouch Gait AuthorsInstitutions
Introduction Cerebral Palsy: motor syndromes Cerebral Palsy: motor syndromes - 2° to brain development Crouch gait – spasticity/contracture 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.
Crouch Gait Body Mechanics Body Mechanics -Knee flexion -Hip flexion -Ankle dorsiflexion Knee and back pain Knee and back pain Quadriceps insufficiency Quadriceps insufficiency Patella alta & Elongation of patellar tendon Patella alta & Elongation of patellar tendon 2° to achilles tendon lengthening 2° to achilles tendon lengthening Stout et al. JBJS 2008 Chambers Eur J Neur 2001
Treatment Gait analysis for evaluation (Pre-op Mov?) Gait analysis for evaluation (Pre-op Mov?) Conservative Conservative -Occupational/Physical therapy -Assistive devices Medical 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.
Surgical Treatment Procedures typically done Procedures typically done –(Get from Halanski) –(Preop and postop x-rays) –(Preop/postop gait analysis)
Surgical Treatment Distal femoral extension osteotomy Distal femoral extension osteotomy Patellar tendon advancement Patellar tendon advancement -Patellar insertion freed -Patellar tendon advanced distally along tibia - Cercalage wire from patella to insertion Stabilize new insertion Combination Combination Stout et al JBJS 2008
Objective To examine the short-term outcomes of hardware failure following patellar tendon advancement in patients with crouch gait To examine the short-term outcomes of hardware failure following patellar tendon advancement in patients with crouch gait 2 Hardware types 2 Hardware types - Cercalage cable - Cercalage wire
Methods Retrospective cohort study radiographs Retrospective cohort study radiographs Inclusion Criteria Inclusion Criteria -Billing codes: patellar advancement -Helen DeVos Children’s Hospital -1/1/03 to 11/2/08 Exclusion criteria Exclusion criteria –Different procedure performed –Age > 17
Methods Patient radiographs Patient radiographs -Cercalage wire vs. cable -Failure vs. Intact Patient records Patient records -Age at procedure -Time to post-op radiograph -Time to failure Fisher’s exact test Fisher’s exact test
Results 16 Patients with 16 Patients with 31 Patellar advancements 31 Patellar advancements Fisher’s exact T-test (p < 0.001) Fisher’s exact T-test (p < 0.001) HardwareWireCable Age (years)1310 # Performed1120 # Failed90 Failure Rate89%0% Avg. Time F/U25890
Discussion Statistically significant advantage to cables Statistically significant advantage to cables Shorter follow-up time Shorter follow-up time Continued observation cables Continued observation cables -1 year follow-up
Conclusion Cables show better outcomes than wires Cables show better outcomes than wires -1 year follow-up for recommendations Possible implications Possible implications –Decrease failed hardware removal –More rapid mobilization post-op Reference
Future Work Continue follow-up for > 1 year Continue follow-up for > 1 year Evaluation of long-term hardware outcomes Evaluation of long-term hardware outcomes Evaluation of patellar advancement on growth plate mechanics Evaluation of patellar advancement on growth plate mechanics Evaluation of gait kinematics Evaluation of gait kinematics Reference
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