The increase of anterior pelvic tilt after crouch gait treatment in patients with cerebral palsy

Abstract Background The increase of anterior pelvic tilt (APT) has been described after the treatment of crouch gait in cerebral palsy (CP). The ideal treatment option for flexed knee gait in CP should provide knee extension improvement in the stance phase without generating the increase of APT. Research question The purpose of this study was to compare three different approaches used for the treatment of crouch gait in CP [distal femur extension osteotomy (DFEO), patellar tendon shortening (PTS) and the combination of DFEO +PTS] regarding the increase of APT after the interventions. Methods The inclusion criteria were: (1) diagnosis of spastic diplegic CP, (2) GMFCS levels I–III, (3) patients who underwent DFEO and/or PTS and (4) with complete documentation in the gait laboratory before and after the intervention. The included patients were divided into 3 groups, according to the procedures performed for crouch gait treatment: PTS (19 patients), DFEO (54 patients) and PTS + DFEO (22 patients). Results During stance phase, knee flexion decreased from 41.6 0 to 13.6 0 in the PTS group ( p   0.001), from 46.0 0 to 30.7 0 in the DFEO group ( p   0.001) and from 52.3 0 to 29.5 0 in the PTS + DFEO group ( p   0.001). APT increased 14 0 ( p   0.001) in the PTS group, 7.1° ( p   0.001) in the DFEO group and 6.6 0 ( p   0.001) in the PTS + DFEO group after surgical intervention. The PTS group presented a more significant deterioration of pelvic tilt than the DFEO ( p  = 0.002) and PTS + DFEO ( p  = 0.001) groups. The increase of APT was higher when HSL was also performed in the PTS + DFEO group ( p  = 0.016). Significance The increase of APT was observed in all studied groups, but it was more significant for those who underwent a PTS. The inclusion of HSL in the surgical plan was related a higher increase of APT in the PTS + DFEO group.