1 - Serviço de Ortopedia Pediátrica, Hospital Dona Estefância – Centro Hospitalar Universitário de Lisboa Central, Lisboa
- III Congresso da SPOP, Vila Nova de Gaia, 14 de Fevereiro de 2020
Introduction:
- Important distinction between walkers and non walkers
- Knee is never isolated from the whole body observation
- Gait analysis (walkers) is a very important aid to decision, but some teams still don’t dispose of this tool and have to decide their patients management without it….
- Particularities of knee approach in CP
Methods:
- Clinical history
- Observation (supine, prone, and/or upright, walking/palpation/testing…)
- Complementary data (X-ray, CT-scan, EOS, motion analysis, EMG, exam under anaesthesia, …)
- Resume problems to solve (or not to…)
Indications for different treatments :
- Techniques to gain active extension: lowering the patella (shortening of patellar tendon, lowering tibial tubercule, with simultaneous tibio-patellar protection, rectus transfer, …)
- Techniques to gain passive extension: extension osteotomy, hamstrings lengthening or transfer, posterior capsulotomy, anterior hemiepiphysiodesis, ...
Clinical Cases, Discussion and Conclusion :
- Goal of obtaining a good knee sagittal (and frontal/horizontal) balance in walkers
- Avoid complications of bi-articular muscles lengthening
- The knee cannot be isolated of the whole body balance
- Tere are recurrent difficulties with non surgical treatments of PC knee
Palavras Chave: cerebral palsy, knee, clinical exam, movement analysis