Long-term outcomes of distal femoral extension osteotomy and patellar tendon advancement in individuals with cerebral palsy

Elizabeth R. Boyer, Jean L. Stout, Jennifer C. Laine, Sarah M. Gutknecht, Lucas H.Araujo De Oliveira, Meghan E. Munger, Michael H. Schwartz, Tom F. Novacheck

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47 Scopus citations


Background: We examined long-term outcomes across the domains of the International Classification of Functioning, Disability and Health for 2 groups of participants with cerebral palsy who demonstrated crouch gait at clinical gait analysis. One group underwent a distal femoral extension osteotomy with patellar tendon advancement (DFEO 1 PTA). The other group received other treatments (non-DFEO 1 PTA). Methods: Fifty-one participants returned for a long-term gait analysis, physical examination, energy consumption test, knee radiographs, and questionnaires (median, 13 years post-DFEO 1 PTA or post-baseline [range, 8 to 21 years]). A subset of participants in the DFEO 1 PTA group also had a short-term analysis (9 to 24 months postoperatively). Results: Participants were reasonably well-matched at baseline, although the DFEO 1 PTA group demonstrated greater crouch: Minimum knee flexion, a median of 37° (width of the interquartile range, 12°) compared with 27° (9°); and knee flexion contracture, a median of 15° (10°) compared with 10° (5°). The gait deviation index (GDI) and sagittal plane knee kinematics were most improved at short term for the DFEO 1 PTA participants, with a subsequent slight decline at longterm analysis. Fewer DFEO 1 PTA participants were in crouch at long term (37% compared with 65%). At the long-term assessment, group scores for function, mobility, participation, quality of life, and most pain questionnaires were similar. Knee pain and osteoarthritis ratings did not differ between the groups. Conclusions: At long-term analysis, DFEO 1 PTA improves stance phase knee extension and knee flexion contracture compared with conventional treatment, but these benefits do not translate to improved activity, participation, or knee pain in early adulthood.

Original languageEnglish (US)
Pages (from-to)31-41
Number of pages11
JournalJournal of Bone and Joint Surgery - American Volume
Issue number1
StatePublished - 2018

Bibliographical note

Funding Information:
Disclosure: This work and E.R. Boyer’s position are supported by the Gait and Motion Outcomes Fund of the Gillette Children’s Foundation. The study sponsors had no role in the study design, collection, analysis, and interpretation of data, writing of the manuscript, or the decision to submit the manuscript for publication. No external funding was received for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/E494).

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