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, Seymour Zimbler, Diane L. Damiano

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations

Abstract

Background Cerebral palsy (CP) is a prevalent group of neuromotor disorders caused by early injury to brain regions or pathways that control movement. Patients with CP exhibit a range of functional motor disabilities and pathologic gait patterns. Crouch gait, characterized by increased knee flexion throughout stance, is a common gait pattern in CP that increases energy costs of walking and contributes to ambulatory decline. Our aim was to perform the first systematic literature review on the effectiveness of interventions utilized to ameliorate crouch gait in CP. Methods Comprehensive searches of five medical databases yielded 38 papers with 30 focused on orthopaedic management. Results Evidence supports the use of initial hamstring lengthenings and rectus femoris transfers, where indicated, for improving objective gait measures with limited data on improving gait speed or gross motor function. In contrast, evidence argues against hamstring transfers and revision hamstring lengthening, with recent interest in more technically demanding corrective procedures. Only eight studies evaluated alternatives to surgery, specifically strength training, botulinum toxin or orthoses, with inconsistent and/or short-lived results. Conclusions Although crouch in CP is recognized clinically as a complex multi-joint, multi-planar gait disorder, this review largely failed to identify interventions beyond those which directly address sagittal plane knee motion, indicating a major knowledge gap. Quality of existing data was notably weak, with few studies properly controlled or adequately sized. Outcomes from specific procedures are confounded by multilevel surgeries. Successful longer term strategies to prevent worsening of crouch and subsequent functional decline are needed. Level of evidence Systematic review.

Original languageEnglish (US)
Pages (from-to)93-105
Number of pages13
JournalGait and Posture
Volume54
DOIs
StatePublished - May 1 2017
Externally publishedYes

Keywords

  • Cerebral palsy
  • Crouch gait
  • Hamstring lengthening
  • Knee flexion
  • Pediatric orthopedics

ASJC Scopus subject areas

  • Biophysics
  • Orthopedics and Sports Medicine
  • Rehabilitation

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