Effectiveness of surgical and non-surgical management of crouch gait in cerebral palsy: A systematic review.
Scott A Galey, Zachary F Lerner, Thomas C Bulea and 2 others
PMID 28279852WHAT IT FOUND
Most evidence for crouch gait in cerebral palsy was for hamstring lengthening, often with other surgeries, and it did not show which procedure works best for a given patient.
Key findings
0130 of the 38 included papers evaluated orthopaedic surgery, and 27 addressed hamstring lengthening or transfer with or without associated procedures.
02Most studies were retrospective and lacked adequate control or comparative groups, and only 4 reported functional measures.
03Botulinum toxin studies showed modest improvement at 2 weeks that disappeared by 12 weeks, and short-term strengthening results were inconsistent.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Nearly all studies were small, retrospective, and uncontrolled, so they cannot show whether surgery caused the changes. Many surgical studies combined hamstring procedures with transfers, osteotomies, or other operations, so the contribution of one part cannot be separated. Definitions of crouch varied across studies, and some samples may have included jump-knee gait, so the groups were not uniform. Only 4 studies reported functional measures, and knee kinematics have only a weak correlation with functional ability. The review excluded studies without 3-dimensional gait kinematics, which likely narrowed the non-surgical interventions captured.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that hamstring lengthening alone is proven to improve function. Many surgical studies combined procedures, and only 4 studies reported functional measures.