Evolution of gait in preschool and primary school children after multilevel orthopedic surgeries performed to correct orthopedic complications of spastic diplegia

Introduction The optimal age for performing multilevel interventions in patients with cerebral palsy is the  period from 10 to 16 years, but indications for eliminating contractures, torsional bone deformities, and foot deformities in children with cerebral palsy of GMFCS level I–III may also occur at an earlier age.

The aim of the work is to evaluate changes in the kinematic and kinetic parameters of gait in children with spastic diplegia who underwent multilevel bilateral surgical interventions for orthopedic complications of cerebral palsy that arose before the onset of pubertal growth acceleration.

Material and Methods 63 children with cerebral palsy, I–III GMFCS. Group 1 (n = 50): average age 7.1 years, no orthopedic interventions had been performed previously. Group 2 (n = 513): average age 7.4 years, isolated interventions were performed at the age of up to 4 years.

Results In group 1: after the operation for two years — an increase in the strength of all extensor muscles with a reliable difference compared to the preoperative level; after 4–5 years — stabilization of the achieved improvements in kinematics. In group 2: after the operation for two years — a decrease in the values of the total working power of the lower limb muscles; after 4 years — decompensation of motor capabilities occurred, the working power of the muscles of the hip and ankle joints did not exceed the initial values, and for the knee joint, the decrease in working power was permanent.

Discussion The positive effect of surgical intervention in both groups is similar and consists of improving the synergistic interaction of muscles.

Conclusion Orthopedic multilevel surgeries performed in children for orthopedic complications before prepubertal growth spurt are associated with functional development only in children who did not undergo early Achilles tendon lengthening or percutaneous fibromyotomies. The result remains stable for 4–5 years after surgery. Isolated Achilles tendon lengthening or percutaneous fibrotomies prevent lower limb muscular development in the long-term follow-up period.

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