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OBJECTIVE: To evaluate whether distal rectus femoris transfer (DRFT) is related to postoperative increase of knee flexion during the stance phase in cerebral palsy (CP). METHODS: The inclusion criteria were Gross Motor Function Classification System (GMFCS) levels I-III, kinematic criteria for stiff-knee gait at baseline, and individuals who underwent orthopaedic surgery and had gait analyses performed before and after intervention. The patients included were divided into the following two groups: NO-DRFT (133 patients), which included patients who underwent orthopaedic surgery without DRFT, and DRFT (83 patients), which included patients who underwent orthopaedic surgery that included DRFT. The primary outcome was to evaluate in each group if minimum knee flexion in stance phase (FMJFA) changed after treatment. RESULTS: The mean FMJFA increased from 13.19° to 16.74° (p=0.003) and from 10.60° to 14.80° (p=0.001) in Groups NO-DRFT and DRFT, respectively. The post-operative FMJFA was similar between groups NO-DRFT and DRFT (p=0.534). The increase of FMJFA during the second exam (from 13.01° to 22.51°) was higher among the GMFCS III patients in the DRFT group (p<0.001). CONCLUSION: In this study, DRFT did not generate additional increase of knee flexion during stance phase when compared to the control group. Level of Evidence III, Retrospective Comparative Study.

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ABSTRACT Objective: To evaluate whether distal rectus femoris transfer (DRFT) is related to postoperative increase of knee flexion during the stance phase in cerebral palsy (CP). Methods: The inclusion criteria were Gross Motor Function Classification System (GMFCS) levels I-III, kinematic criteria for stiff-knee gait at baseline, and individuals who underwent orthopaedic surgery and had gait analyses performed before and after intervention. The patients included were divided into the following two groups: NO-DRFT (133 patients), which included patients who underwent orthopaedic surgery without DRFT, and DRFT (83 patients), which included patients who underwent orthopaedic surgery that included DRFT. The primary outcome was to evaluate in each group if minimum knee flexion in stance phase (FMJFA) changed after treatment. Results: The mean FMJFA increased from 13.19° to 16.74° (p=0.003) and from 10.60° to 14.80° (p=0.001) in Groups NO-DRFT and DRFT, respectively. The post-operative FMJFA was similar between groups NO-DRFT and DRFT (p=0.534). The increase of FMJFA during the second exam (from 13.01° to 22.51°) was higher among the GMFCS III patients in the DRFT group (p<0.001). Conclusion: In this study, DRFT did not generate additional increase of knee flexion during stance phase when compared to the control group. Level of Evidence III, Retrospective Comparative Study.

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OBJECTIVE: To identify gait patterns in a large group of children with diplegic cerebral palsy and to characterize each group according to age, Gross Motor Function Classification System (GMFCS) level, Gait Deviation Index (GDI) and previous surgical procedures. METHODS: ONE THOUSAND EIGHT HUNDRED AND FIVE PATIENTS WERE DIVIDED IN SEVEN GROUPS REGARDING OBSERVED GAIT PATTERNS: jump knee, crouch knee, recurvatum knee, stiff knee, asymmetric, mixed and non-classified. RESULTS: The asymmetric group was the most prevalent (48.8%). The jump knee (9.6 years old) and recurvatum (9.4 years old) groups had mean age lower than the other groups. The lowest GDI (43.58) was found in the crouch group. There were more children classified within GMFCS level III in the crouch and mixed groups. Previous surgical procedures on the triceps surae were more frequent in stiff knee and mixed groups. The jump knee group received less and the stiff-knee group more surgical procedures at hamstrings than others. CONCLUSIONS: The asymmetrical cases were the most frequent within a group of diplegic patients. Individuals with crouch gait pattern were characterized by the lowest GDI and the highest prevalence of GMFCS III, while patients with stiff knee exhibited a higher percentage of previous hamstring lengthening in comparison to the other groups. Level of Evidence III, Retrospective Comparative Study.

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Identificar padrões de marcha em um grande grupo de crian-ças com paralisia cerebral (PC) tipo diplegia espástica e caracterizarcada grupo de acordo com a idade, nível do Gross Motor FunctionClassification System (GMFCS) e Gait Deviation Index (GDI) e cirurgiasprévias. Métodos: Foram divididos em sete grupos 1805 pacientescom base nos padrões de marcha observados: joelho saltitante, agachamento,recurvatum, joelho rígido, assimétrico, misto, e não classificável.Resultados: O grupo assimétrico foi o mais prevalente (48,8%).Os grupos joelho saltitante (9,6 anos) e recurvatum (9,4 anos) exibiramidade média menor que os demais grupos. O GDI mais baixo (43,58)foi observado no grupo agachamento. Notaram-se mais pacientesclassificados como nível III do GMFCS nos grupos agachamento emisto. Cirurgias prévias no tríceps sural foram mais frequentes nosgrupos joelho rígido e misto. O grupo joelho saltitante recebeu menornúmero de procedimentos cirúrgicos prévios nos isquiotibais, enquantoque o grupo com joelho rígido recebeu maior número, quandocomparado aos demais. Conclusões: Os casos assimétricos forammais frequentes, mesmo em grupo de pacientes diplégicos. Pacientescom padrão em agachamento foram caracterizados pelo GDI maisbaixo e prevalência do nível III no GMFCS, enquanto que o grupojoelho rígido exibiu uma porcentagem maior de alongamento préviodos isquiotibiais em comparação com os demais grupos. Nível deEvidência III, Estudo Retrospectivo Comparativo...

To identify gait patterns in a large group of childrenwith diplegic cerebral palsy and to characterize each groupaccording to age, Gross Motor Function Classification System(GMFCS) level, Gait Deviation Index (GDI) and previous surgicalprocedures. Methods: One thousand eight hundred and fivepatients were divided in seven groups regarding observed gaitpatterns: jump knee, crouch knee, recurvatum knee, stiff knee,asymmetric, mixed and non-classified. Results: The asymmetricgroup was the most prevalent (48.8%). The jump knee (9.6 yearsold) and recurvatum (9.4 years) groups had mean age lowerthan the other groups. The lowest GDI (43.58) was found in thecrouch group. There were more children classified within GMFCSlevel III in the crouch and mixed groups. Previous surgical procedureson the triceps surae were more frequent in stiff kneeand mixed groups. The jump knee group received less and thestiff-knee group more surgical procedures at hamstrings thanothers. Conclusions: The asymmetrical cases were the most frequentwithin a group of diplegic patients. Individuals with crouchgait pattern were characterized by the lowest GDI and the highestprevalence of GMFCS III, while patients with stiff knee exhibited ahigher percentage of previous hamstring lengthening in comparisonto the other groups. Level of Evidence III, RetrospectiveComparative Study...

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OBJECTIVES: To show the preoperative planning and results from surgical treatment for paralytic hip dislocation among patients with cerebral palsy. The techniques used were proximal femoral varus derotation osteotomy in association with Dega iliac osteotomy, without opening the joint capsule. METHODS: We performed a retrospective review of ten hips in eight patients with spastic quadriplegic cerebral palsy who underwent surgical treatment between 2003 and 2005, with the same surgical technique. The pre and postoperative clinical and radiological parameters, and the preoperative planning using an image intensifier, were assessed. The clinical parameters analyzed were: pain, hygiene-related difficulties and positioning difficulties. The radiological parameters were Reimer's index, the acetabular index and the neck-shaft angle. These results were subjected to statistical analysis. RESULTS: We obtained good results with this technique. After a mean follow-up of three years, all the hips were observed to be stable at the last assessment, and there was a high degree of satisfaction among the families in relation to the treatment. We also showed that preoperative planning using an image intensifier allowed us to reduce and stabilize these hips without the need for capsuloplasty. CONCLUSION: The authors conclude that in treating hip dislocation among spastic quadriplegic cerebral palsy patients, capsuloplasty is unnecessary for stabilizing the coxofemoral joint.

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OBJETIVO: Mostrar o planejamento pré-operatório, e os resultados do tratamento cirúrgico da luxação paralítica do quadril em pacientes com paralisia cerebral. A técnica utilizada foi a osteotomia derrotatória e varizante do fêmur proximal, associada à osteotomia do ilíaco tipo Dega, sem abertura da cápsula articular. MÉTODOS: Realizamos um estudo retrospectivo de 10 quadris em oito pacientes com paralisia cerebral tipo tetraparesia espástico, submetidos a tratamento cirúrgico entre 2003 e 2005 com a mesma técnica cirúrgica. Foram avaliados parâmetros clínicos e radiográficos pré e pós-operatórios, bem como o planejamento pré-operatório com uso do intensificador de imagem. Os parâmetros clínicos analisados foram: dor, dificuldade de higiene e dificuldade de posicionamento. Os parâmetros radiológicos foram os índices de Reimers, índice acetabular e ângulo cervicodiafisário. Estes resultados foram submetidos a análise estatística. RESULTADOS: Obtivemos bons resultados com esta técnica. Com um seguimento médio de três anos, todos os quadris estavam reduzidos na última consulta, com alto grau de satisfação dos familiares, em relação ao tratamento. Além disso, mostramos que o planejamento pré-operatório com uso do intensificador de imagem nos permite a redução e estabilização desses quadris sem a necessidade de capsuloplastia. CONCLUSÃO: Os autores concluíram que no tratamento da luxação do quadril dos pacientes com paralisia cerebral tetraparéticos espásticos com o planejamento pré-operatório, não é necessária a capsuloplastia para estabilização da articulação coxofemoral.

OBJECTIVES: To show the preoperative planning and the results of surgical treatment for paralytic hip dislocation in children with cerebral palsy. The techniques used were proximal femoral varus derotation osteotomy and Dega osteotomy without opening of the joint capsule. METHODS: We performed a retrospective review of ten hips in eight patients with cerebral palsy with spastic quadriplegia treated with surgery from 2003 to 2005, by the same surgical technique. Were assessed clinical and radiological outcomes before and after surgery, as well as the preoperative planning with the use of fluoroscope. The clinical parameters analyzed were: pain, difficulty performing personal hygiene, and sitting balance. The radiological parameters were Reimer's index, acetabular index and neck-shaft angle. These results were submitted to statistical analysis. RESULTS: We obtained good results with this technique. After an average follow-up of three years, all hips were stable in the last assessment, and there was a high level of satisfaction among the families in relation to the treatment. We also show that preoperative planning with fluoroscopy enables the reduction and stabilization of the hips without the need for capsuloplasty. CONCLUSION: The authors conclude that in the treatment of hip dislocation in patients with Cerebral Palsy with spastic quadriplegia, it is not necessary to open the joint capsule to stabilize the coxofemoral joint.

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