Supra Condylar Femoral Extension Osteotomy with Patellar Tendon Advancement in Management of Fixed Flexion Knee Deformity of Crouch Gait in Cerebral Palsy

Background: Cerebral palsy (CP) leads to activity limitation due to non-progressive disturbances of the developing fetal or infant brain. It is often accompanied by disturbances of sensation, perception, cognition, communication, behavior, epilepsy and by secondary musculoskeletal problems. Aim and objectives: The current study aimed to evaluate the results of supra condylar femoral extension osteotomy (SCFEO) and patellar tendon advancement (PTA) in the treatment of fixed knee flexion deformity (FKFD) in patients with spastic ambulatory CP. Subjects and methods: This study included 40 patients. They were assessed preoperatively by clinical and radiological means. The local examinations included tests for extensor lag mechanism, measurement of fixed knee flexion and popliteal angles), and the gait pattern video recording, radiographic measurements (Koshino’s index in knee flexion 30-90 degrees). Postoperatively, at 6 and 12 months after surgery, the same tests were repeated to estimate clinical and radiographic improvements. Result: There was progressive reduction of fixed knee flexion angle from preoperative 28.10±5.20 to 8.47±1.56 and 4.73±3.68 after 6 and 12 months. The extension lag angle reduced from 15.05±2.73 to 7.97±1.39 and 2.12±2.45, after 6 and 12 months respectively. The observational gait scale showed a significant increase at 6 months when compared to preoperative values (13.05±1.72 vs 9.65±1.37, respectively). The growth motor fictional classification score grades were II in 17.5% preoperatively that increased to 25% and 30% after 6 and 12 months respectively. The preoperative Koshino index was 1.42±0.29, and after 6 months, it was 1.01±0.68. Most subjects (72.5%) improved with no complications. The common complications were superficial infections of the K wires (10%), cast ulcers (7.5%), recurrence of more than 10° FKFA (5%) and stretch on the common peroneal nerve (2.5%). Conclusion: The SCFEO and PTA in the treatment of FKFD in patients with spastic ambulatory CP is an effective and relatively safe intervention.