Background

Increased terminal swing knee flexion (TSKF) impacts on step length, walking efficiency and may lead to knee flexion in stance in cerebral palsy (CP). Surgical lengthening of the hamstrings is often used to address this issue, but outcomes are inconsistent. There is an established association between TSKF and functional shortening or reduced lengthening velocity of the hamstrings. However, the aetiology of increased TSKF in CP is complex and additional associated factors are not well understood. An examination of clinical and kinematic factors associated with increased TSKF may demonstrate this complexity, highlight the multifactorial nature of this feature and provide a basis for enhanced treatment decision making.

Research question

What kinematic and clinical factors are associated with TSKF in individuals with CP?.

Methods

A retrospective database review was conducted. Individuals with bilateral CP were identified and a subset was extracted which represented the full spectrum of degree of TSKF in the database. The total dataset for analysis was n = 88. Associations between absolute clinical and kinematic data and TSKF were explored using correlation analysis, linear and multivariate regression. Time series data were examined across quartiles using statistical parametric mapping analysis of variance (SPM ANOVA).

Results

Increased TSKF was associated with overall gait impairment (GDI), degree of knee flexion throughout the stride, knee extension velocity, hamstring lengthening characteristics and functional status (GMFCS). There was no relationship to walking speed or clinical measures of hamstring extensibility on clinical assessment.

Significance

TSKF is associated with multiple factors which clinicians need to consider when devising treatment strategies. Caution is advised when relying on degree of TSKF to independently guide surgical decision-making.

中文翻译：

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与脑瘫患者终末摆动膝关节屈曲增加相关的因素

背景

增加终末摆动膝关节屈曲 (TSKF) 会影响步长、步行效率，并可能导致脑瘫 (CP) 站立时膝关节屈曲。腘绳肌的手术延长通常用于解决这个问题，但结果并不一致。TSKF 与腘绳肌功能性缩短或延长速度降低之间存在既定关联。然而，CP 中 TSKF 增加的病因很复杂，其他相关因素尚不清楚。对与 TSKF 增加相关的临床和运动学因素的检查可能会证明这种复杂性，突出该特征的多因素性质，并为增强治疗决策提供基础。

研究问题

哪些运动学和临床因素与 CP 患者的 TSKF 相关？

方法

进行了回顾性数据库审查。确定了双侧 CP 的个体并提取了一个子集，该子集代表了数据库中 TSKF 程度的全谱。用于分析的总数据集为 n = 88。使用相关分析、线性和多元回归探索绝对临床和运动学数据与 TSKF 之间的关联。使用方差统计参数映射分析（SPM ANOVA）跨四分位数检查时间序列数据。

结果

增加的 TSKF 与整体步态障碍 (GDI)、整个步幅的膝关节屈曲程度、膝关节伸展速度、腘绳肌延长特征和功能状态 (GMFCS) 相关。在临床评估中，与步行速度或腘绳肌伸展性的临床测量无关。

意义

TSKF 与临床医生在制定治疗策略时需要考虑的多种因素相关。当依靠 TSKF 的程度来独立指导手术决策时，建议谨慎。