Background

The optimal management of impaired knee joint function in patients with cerebral palsy (CP) remains a significant and ongoing challenge in paediatric orthopaedic surgery.

Research question

What are the clinical and functional outcomes after operative and non-operative orthopaedic interventions for knee joint impairment in patients with CP?

Methods

This systematic review and meta-analysis of orthopaedic interventions for the management of knee joint impairment in paediatric CP patients evaluated study-level data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. We performed searches of the following electronic databases from their dates of inception to November 2019: Medline (Ovid), Embase (Ovid) and Pubmed. We extracted mean differences in pre-operative and post-operative measurements for the following outcomes: minimum knee flexion in stance; knee flexion at initial contact; maximum knee flexion in swing; range of motion; popliteal angle; fixed flexion deformity angle; and mean pelvic tilt.

Results

Sixty-nine retrospective cohort studies, prospective cohort studies and RCTs comprising 2991 patients were included with 4578 knees analysed. Included studies were of sufficient quality as assessed by the MOOSE checklist. Operative interventions showed significant improvement in knee flexion at initial contact, knee flexion in stance, range of motion, popliteal angle and fixed flexion deformity which were comparable when subgrouped according to operative technique. In contrast, non-operative techniques and botulinum toxin injection did not confer significant improvements. Operative interventions for knee joint impairment led to increased mean pelvic tilt and reduced maximum knee flexion in swing.

Significance

This review provides strong evidence that operative interventions for the management of knee joint impairment in cerebral palsy patients improve knee kinematics and clinical examination findings.

中文翻译：

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骨性瘫痪膝关节损伤的骨科管理：系统评价和荟萃分析。

背景

脑瘫（CP）患者膝关节功能受损的最佳治疗仍然是小儿骨科手术中一项重大且持续的挑战。

研究问题

CP患者膝关节损伤的手术和非手术骨科干预后的临床和功能结局如何？

方法

这项针对儿童CP患者膝关节损伤管理的骨科干预措施的系统评价和荟萃分析根据系统评价和荟萃分析的首选报告项目（PRISMA）声明评估了研究水平的数据。我们从以下日期开始到2019年11月对以下电子数据库进行了搜索：Medline（Ovid），Embase（Ovid）和Pubmed。我们提取了以下结果在术前和术后测量中的平均差异：最小的膝关节屈曲姿势；初次接触时膝盖弯曲；挥杆时膝盖最大屈曲；活动范围; lite角 固定屈曲畸形角；和平均骨盆倾斜。

结果

包括29991名患者的69项回顾性队列研究，前瞻性队列研究和RCT纳入了4578例膝关节。通过MOOSE清单评估，纳入的研究具有足够的质量。手术干预显示，初次接触时膝关节屈曲，站立时膝关节屈曲，运动范围，pop骨角和固定屈曲畸形有显着改善，按手术技术分组时可比。相反，非手术技术和肉毒杆菌毒素注射并未带来明显的改善。膝关节功能障碍的手术干预导致平均骨盆倾斜增加和摆动中最大膝关节屈曲减少。

意义

这篇综述提供了有力的证据表明，对脑瘫患者的膝关节损伤进行手术治疗可改善膝关节运动学和临床检查结果。