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

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.