Patellar tendon plication with novel technique in patella alta as a part of management of cerebral palsy crouch gait / Yasser Abdullah Elsayed Mattar ; Supervised Ahmad Abdelaziz Ahmad , Hassan Magdy Elbarbary , Mohammad Mahmoud Hegazy

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Orthopedic Surgery

Introduction: Persistent crouch gait is a common problem exhibited by children, adolescents, and young adults with spastic cerebral palsy, which is typically characterized by excessive knee {uFB02}exion throughout stance phase, Once the crouch gait reaches a certain level of severity in the child, the degree of knee flexion and associated symptoms may progress rapidly because of high stresses at the knee and failure of the knee extensor mechanism. Knee pain, patella alta, and fragmentation or fracture of the inferior pole of the patella all have been documented in this clinical setting.[87] Material and methods: Our population was 20 knees (10 patients) with cerebral palsy, spastic diplegia.The inclusion criteria were ambulatory children (GMFCS II and III) , with crouch gait and patella alta that was proved by Koshino index in 30-90 degrees of knee flexion. We identified patient age, sex, functional status, associated surgical procedures .Assessment was done clinically by using extensor lag test preoperative and postoperative.Radiological assessement was done by koshino index to assess patellar height preoperative and postoperative. Follow up period was (shortest 6 months and longest 18 months).Results: All patients included in this study showed improvement in extensor lag mechanism Mean from 24.75±10.45 SD to 7.15 ±5.06 after 1 year follow up , also all patient included in this study showed radiological improvement ( koshino index).Mean improved from 1.47±0.17 SD to 1.17 ±0.11 SD and remained at 6,12,24 weeks and after 1 year

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