American Journal of Physical Medicine & Rehabilitation, 2021
Abstract This review sought to describe and analyze published protocols for rehabilitation after ... more Abstract This review sought to describe and analyze published protocols for rehabilitation after single-event multilevel surgery for people with cerebral palsy, to identify their differences and limits, and to introduce a common step-by-step framework for future descriptions and assessments of postoperative rehabilitation protocols. The MEDLINE, Embase, CINAHL, and the Cochrane Library databases were searched. Inclusion criteria were as follows: (1) single-event multilevel surgery, (2) full-text reports published after 1985, and (3) articles with a method section describing the rehabilitation protocol. Interventions were coded using the Oxford Levels of Evidence and the Methodological Index for Non-Randomized Studies Index. Twenty-four articles were included in the review. Studies included patients aged 4–30 yrs with spastic cerebral palsy (hemiplegia, diplegia, and quadriplegia). The mean postoperative rehabilitation duration was 4.5 mos, with 4 sessions per week, and rehabilitation took place in a rehabilitation center. This review provides relevant information about the modalities, contents, limits, and difficulties associated with the post-SEMS rehabilitation protocol reported in the literature. Pain was identified as a major problem. A more precise and comprehensive description of post-SEMS rehabilitation protocols would be useful. The proposed five-step framework could be used by future studies to standardize their protocol description in terms of objective, content, and intensity.
Revue de Chirurgie Orthopédique et Traumatologique, 2016
S88 91 e réunion annuelle de la Société franç aise de chirurgie orthopédique et traumatologique /... more S88 91 e réunion annuelle de la Société franç aise de chirurgie orthopédique et traumatologique / Revue de chirurgie orthopédique et traumatologique 102 (2016) S73-S190 39 Luxation neurologique de hanches de l'enfant. Résultat de la triple ostéotomie pelvienne de Tönnis Neurological hip dislocation in children. Result of Tönnis triple osteotomy
Movement & Sport Sciences - Science & Motricité, 2016
Increased knee flexion at initial contact (KFIC) is a common gait deviation in Cerebral Palsy. Ha... more Increased knee flexion at initial contact (KFIC) is a common gait deviation in Cerebral Palsy. Hamstring lengthening surgery (HL) aims to decrease KFIC, but may affect pelvic tilt (PTIC). In this work, we design a decision-making tool that simulates the effect of orthopedic surgery, with or without HL, on KFIC and PTIC. The postoperative parameters are estimated given preoperative gait, physical examination and surgery. Nonlinear regressions are performed by feedforward neural networks. On test, the mean root-mean squared error for KFIC and PTIC are 9° and 5° respectively. Sixty-three percent and 90% of the lower limbs are estimated within a 10° error range for KFIC and PTIC respectively. The simulator is able to give good estimations independently of the surgery type.
Comprendre la Paralysie Cérébrale et les Troubles Associés, 2017
Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y ... more Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y compris la reproduction) est assujettie à sa politique d'utilisation que vous pouvez consulter en ligne.
Orthopaedics & Traumatology: Surgery & Research, 2017
Background: Patellalowering aims to improve quadriceps function as a means of correcting crouch g... more Background: Patellalowering aims to improve quadriceps function as a means of correcting crouch gait in patients with cerebral palsy (PC). Few studies have assessed the effects of patella lowering as a component of multilevel surgery. Hypothesis: Including patella lowering into the components of multilevel surgery is beneficial in patients with crouch gait and patella alta. Material et methods: In 12 lower limbs with patella alta (Caton-Deschamps index >1.4) in 41 children with cerebral palsy, patella lowering was performed, without distal femoral extension osteotomy or hamstring release. Among limbs with similar surgical procedures (e.g., hamstring lengthening, rectus femoris transfer) except for patella lowering, controls were selected retrospectively by matching on a propensity score for patella lowering. The propensity score was computed based on preoperative knee flexion contracture, knee extension lag, and minimum knee flexionat mid-stance. Clinical and 3D kinematic data were compared between the two groups. Results:The improvement in minimum knee flexion at mid-stance was significantly greater in the group with patellar lowering (-24°±12°vs.-12°±7°).The Gait Deviation Index improved similarly in the two groups. Knee flexion contracture improved only in the group with patellar lowering. Extension lagdid not improve in either group. Peak knee flexion during the swing phase remained unchanged in both groups. Discussion: Patellar lowering is effective in diminishing minimum knee flexion at mid-stance in patients with patella alta and crouch gait due to cerebral palsy. Patellar lowering has not adverse effects on gait. These findings cannot be assumed to apply to patients with normal patellar height.
Proceedings of the International Conference on Pattern Recognition Applications and Methods, 2015
Cerebral Palsy (CP) affects walking and often produces excessive knee flexion at initial contact ... more Cerebral Palsy (CP) affects walking and often produces excessive knee flexion at initial contact (KFIC). Hamstring lengthening surgery (HL) is applied to decrease KFIC. The objective of this work is to design a simulator of the effect of HL on KFIC that could be used as a decision-making tool. The postoperative KFIC is estimated given the preoperative gait, physical examination and the type of surgery. Nonlinear data fitting is performed by feedforward neural networks. The mean regression error on test is 9.25 • and 63.21% of subjects are estimated within an error range of 10 •. The simulator is able to give good estimations independently of the preoperative gait parameters and the type of surgery. This system predicts the outcomes of orthopaedic surgery on CP children with real gait parameters, and not with qualitative characteristics.
Background: Various techniques have been proposed for the treatment of cavovarus feet (CVF). The ... more Background: Various techniques have been proposed for the treatment of cavovarus feet (CVF). The aim of this study was to report outcomes of the revisited Meary's dorsal closing wedge tarsectomy for fixed CVF secondary to Charcot-Marie-Tooth (CMT) disease. Methods: All CVF operated on between 1977 and 2011 were included. The tarsectomy design was modified from its original description and systemically combined with a plantar fascia release, a Dwyer osteotomy and a proximal extension osteotomy of the 1st metatarsal bone if required. Outcomes were assessed by 2 functional scores and radiographically. Results: Among the 26 feet (20 patients), the Wicart and Seringe score was very good or good, fair and poor in respectively 58%, 23% and 19% of the feet. Hindfoot and midfoot AOFASs were of 95.5 and 75 respectively. All radiographic measures were significantly improved. Conclusions: This complete revisited procedure is an efficient and safe surgical technique for the treatment of the CMT disease CVF. Level of evidence: Level IV.
Background: Various techniques have been proposed for the treatment of cavovarus feet (CVF). The ... more Background: Various techniques have been proposed for the treatment of cavovarus feet (CVF). The aim of this study was to report outcomes of the revisited Meary's dorsal closing wedge tarsectomy for fixed CVF secondary to Charcot-Marie-Tooth (CMT) disease. Methods: All CVF operated on between 1977 and 2011 were included. The tarsectomy design was modified from its original description and systemically combined with a plantar fascia release, a Dwyer osteotomy and a proximal extension osteotomy of the 1st metatarsal bone if required. Outcomes were assessed by 2 functional scores and radiographically. Results: Among the 26 feet (20 patients), the Wicart and Seringe score was very good or good, fair and poor in respectively 58%, 23% and 19% of the feet. Hindfoot and midfoot AOFASs were of 95.5 and 75 respectively. All radiographic measures were significantly improved. Conclusions: This complete revisited procedure is an efficient and safe surgical technique for the treatment of the CMT disease CVF. Level of evidence: Level IV.
Purpose of the study: The posterior paraspinal approach to the lumbar spine was initially describ... more Purpose of the study: The posterior paraspinal approach to the lumbar spine was initially described and promoted by Wiltse for posterolateral arthrodesis of the lumbosacral junction in patients with spondylolisthesis. Despite technical improvements proposed by Wiltse, the muscular cleavage is still poorly localized in the sacrospinalis muscle. The purpose of this work was to provide a more accurate anatomic description of this spinal approach and to describe anatomic landmarks to facilitate execution of the procedure. Material and methods: Fifty anatomic specimens were dissected (27 male and 23 female cadavers); 33 had been embalmed. The anatomy study used a bilateral approach to the spine. The exact anatomic localization of the muscle cleavage was noted. Measures were taken in relation to the mid line of the L4 spinatus process. Results: In all specimens, the muscle cleavage lay between the multifidus and longissimus heads of the sacrospinalis muscle. A fibrous partition was noted ...
segment length, and T1-12 height. Results: There were five females and five males with an average... more segment length, and T1-12 height. Results: There were five females and five males with an average age of 8+4 (5+7-14+5). Initial Cobb angle averaged 67.6 degrees (47-93) with an average operative correction of 61% (22-90%). Average follow-up was 28 months. Initial post-operative correction on average of 41 degrees (61%) was achieved. The Cobb angle had an average progression of 2.39 degrees/year (8 degrees correction/year-10 degrees progression/year), with an average final Cobb angle of 31.4 degrees (4-52). Most importantly, the intercalary segment grew, on average, 0.26 mm per vertebral body per year. The overall average growth achieved was 2.94 cm. There were two cases of superficial skin infection and one case requiring revision for prominent implant. Conclusion: This initial experience with the MLTC is encouraging. It shows the intercalary segment is indeed growing, while the Cobb angle is being controlled and repeated surgical procedures are being avoided. Further investigation into the effects on the sagittal profile, longevity of the implants, and comparison to other treatment options will be interesting moving forward.
Cualquier escoliosis evolutiva debe tratarse de modo eficaz. La fisioterapia es útil pero por sí ... more Cualquier escoliosis evolutiva debe tratarse de modo eficaz. La fisioterapia es útil pero por sí sola resulta insuficiente. El tratamiento ortopédico mediante corsé permite hacer más lento el empeoramiento de la deformación. En caso de fracaso o de dificultades relacionadas con el cumplimiento por parte del paciente, la evolución de la deformación puede hacer que, a partir de la adolescencia, o a más largo plazo, en la edad adulta, ésta se vuelva inaceptable. En este caso resulta necesario proponer un tratamiento quirúrgico con una instrumentación que permita la corrección de la deformación y un injerto óseo que asegure su estabilización. Estas intervenciones, practicadas de acuerdo con normas estrictas, proporcionan resultados satisfactorios y permiten una vida totalmente normal, a condición de que se mantenga una movilidad lumbar residual suficiente.
Le traitement chirurgical des deformations orthopediques secondaires a une infirmite motrice d’or... more Le traitement chirurgical des deformations orthopediques secondaires a une infirmite motrice d’origine cerebrale (IMOC) a considerablement evolue depuis une dizaine d’annees. L'apport des donnees de physiologie de l’ensemble musculo-tendineux [1], l'analyse instrumentale (EMG, cinematique, cinetique) venant completer les donnees de l’examen clinique, l'amelioration des suites operatoires par l’utilisation d’antalgiques et de decontracturants appropries et l'integration du traitement chirurgical dans un ensemble orthopedique comprenant la reeducation et un appareillage adequat ont contribue a l’amelioration des resultats des traitements chirurgicaux. Nous envisagerons les differentes attitudes vicieuses ou deformations rencontrees en insistant sur leur mecanisme de production et les possibilites therapeutiques medicales ou chirurgicales [2].
American Journal of Physical Medicine & Rehabilitation, 2021
Abstract This review sought to describe and analyze published protocols for rehabilitation after ... more Abstract This review sought to describe and analyze published protocols for rehabilitation after single-event multilevel surgery for people with cerebral palsy, to identify their differences and limits, and to introduce a common step-by-step framework for future descriptions and assessments of postoperative rehabilitation protocols. The MEDLINE, Embase, CINAHL, and the Cochrane Library databases were searched. Inclusion criteria were as follows: (1) single-event multilevel surgery, (2) full-text reports published after 1985, and (3) articles with a method section describing the rehabilitation protocol. Interventions were coded using the Oxford Levels of Evidence and the Methodological Index for Non-Randomized Studies Index. Twenty-four articles were included in the review. Studies included patients aged 4–30 yrs with spastic cerebral palsy (hemiplegia, diplegia, and quadriplegia). The mean postoperative rehabilitation duration was 4.5 mos, with 4 sessions per week, and rehabilitation took place in a rehabilitation center. This review provides relevant information about the modalities, contents, limits, and difficulties associated with the post-SEMS rehabilitation protocol reported in the literature. Pain was identified as a major problem. A more precise and comprehensive description of post-SEMS rehabilitation protocols would be useful. The proposed five-step framework could be used by future studies to standardize their protocol description in terms of objective, content, and intensity.
Revue de Chirurgie Orthopédique et Traumatologique, 2016
S88 91 e réunion annuelle de la Société franç aise de chirurgie orthopédique et traumatologique /... more S88 91 e réunion annuelle de la Société franç aise de chirurgie orthopédique et traumatologique / Revue de chirurgie orthopédique et traumatologique 102 (2016) S73-S190 39 Luxation neurologique de hanches de l'enfant. Résultat de la triple ostéotomie pelvienne de Tönnis Neurological hip dislocation in children. Result of Tönnis triple osteotomy
Movement & Sport Sciences - Science & Motricité, 2016
Increased knee flexion at initial contact (KFIC) is a common gait deviation in Cerebral Palsy. Ha... more Increased knee flexion at initial contact (KFIC) is a common gait deviation in Cerebral Palsy. Hamstring lengthening surgery (HL) aims to decrease KFIC, but may affect pelvic tilt (PTIC). In this work, we design a decision-making tool that simulates the effect of orthopedic surgery, with or without HL, on KFIC and PTIC. The postoperative parameters are estimated given preoperative gait, physical examination and surgery. Nonlinear regressions are performed by feedforward neural networks. On test, the mean root-mean squared error for KFIC and PTIC are 9° and 5° respectively. Sixty-three percent and 90% of the lower limbs are estimated within a 10° error range for KFIC and PTIC respectively. The simulator is able to give good estimations independently of the surgery type.
Comprendre la Paralysie Cérébrale et les Troubles Associés, 2017
Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y ... more Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y compris la reproduction) est assujettie à sa politique d'utilisation que vous pouvez consulter en ligne.
Orthopaedics & Traumatology: Surgery & Research, 2017
Background: Patellalowering aims to improve quadriceps function as a means of correcting crouch g... more Background: Patellalowering aims to improve quadriceps function as a means of correcting crouch gait in patients with cerebral palsy (PC). Few studies have assessed the effects of patella lowering as a component of multilevel surgery. Hypothesis: Including patella lowering into the components of multilevel surgery is beneficial in patients with crouch gait and patella alta. Material et methods: In 12 lower limbs with patella alta (Caton-Deschamps index >1.4) in 41 children with cerebral palsy, patella lowering was performed, without distal femoral extension osteotomy or hamstring release. Among limbs with similar surgical procedures (e.g., hamstring lengthening, rectus femoris transfer) except for patella lowering, controls were selected retrospectively by matching on a propensity score for patella lowering. The propensity score was computed based on preoperative knee flexion contracture, knee extension lag, and minimum knee flexionat mid-stance. Clinical and 3D kinematic data were compared between the two groups. Results:The improvement in minimum knee flexion at mid-stance was significantly greater in the group with patellar lowering (-24°±12°vs.-12°±7°).The Gait Deviation Index improved similarly in the two groups. Knee flexion contracture improved only in the group with patellar lowering. Extension lagdid not improve in either group. Peak knee flexion during the swing phase remained unchanged in both groups. Discussion: Patellar lowering is effective in diminishing minimum knee flexion at mid-stance in patients with patella alta and crouch gait due to cerebral palsy. Patellar lowering has not adverse effects on gait. These findings cannot be assumed to apply to patients with normal patellar height.
Proceedings of the International Conference on Pattern Recognition Applications and Methods, 2015
Cerebral Palsy (CP) affects walking and often produces excessive knee flexion at initial contact ... more Cerebral Palsy (CP) affects walking and often produces excessive knee flexion at initial contact (KFIC). Hamstring lengthening surgery (HL) is applied to decrease KFIC. The objective of this work is to design a simulator of the effect of HL on KFIC that could be used as a decision-making tool. The postoperative KFIC is estimated given the preoperative gait, physical examination and the type of surgery. Nonlinear data fitting is performed by feedforward neural networks. The mean regression error on test is 9.25 • and 63.21% of subjects are estimated within an error range of 10 •. The simulator is able to give good estimations independently of the preoperative gait parameters and the type of surgery. This system predicts the outcomes of orthopaedic surgery on CP children with real gait parameters, and not with qualitative characteristics.
Background: Various techniques have been proposed for the treatment of cavovarus feet (CVF). The ... more Background: Various techniques have been proposed for the treatment of cavovarus feet (CVF). The aim of this study was to report outcomes of the revisited Meary's dorsal closing wedge tarsectomy for fixed CVF secondary to Charcot-Marie-Tooth (CMT) disease. Methods: All CVF operated on between 1977 and 2011 were included. The tarsectomy design was modified from its original description and systemically combined with a plantar fascia release, a Dwyer osteotomy and a proximal extension osteotomy of the 1st metatarsal bone if required. Outcomes were assessed by 2 functional scores and radiographically. Results: Among the 26 feet (20 patients), the Wicart and Seringe score was very good or good, fair and poor in respectively 58%, 23% and 19% of the feet. Hindfoot and midfoot AOFASs were of 95.5 and 75 respectively. All radiographic measures were significantly improved. Conclusions: This complete revisited procedure is an efficient and safe surgical technique for the treatment of the CMT disease CVF. Level of evidence: Level IV.
Background: Various techniques have been proposed for the treatment of cavovarus feet (CVF). The ... more Background: Various techniques have been proposed for the treatment of cavovarus feet (CVF). The aim of this study was to report outcomes of the revisited Meary's dorsal closing wedge tarsectomy for fixed CVF secondary to Charcot-Marie-Tooth (CMT) disease. Methods: All CVF operated on between 1977 and 2011 were included. The tarsectomy design was modified from its original description and systemically combined with a plantar fascia release, a Dwyer osteotomy and a proximal extension osteotomy of the 1st metatarsal bone if required. Outcomes were assessed by 2 functional scores and radiographically. Results: Among the 26 feet (20 patients), the Wicart and Seringe score was very good or good, fair and poor in respectively 58%, 23% and 19% of the feet. Hindfoot and midfoot AOFASs were of 95.5 and 75 respectively. All radiographic measures were significantly improved. Conclusions: This complete revisited procedure is an efficient and safe surgical technique for the treatment of the CMT disease CVF. Level of evidence: Level IV.
Purpose of the study: The posterior paraspinal approach to the lumbar spine was initially describ... more Purpose of the study: The posterior paraspinal approach to the lumbar spine was initially described and promoted by Wiltse for posterolateral arthrodesis of the lumbosacral junction in patients with spondylolisthesis. Despite technical improvements proposed by Wiltse, the muscular cleavage is still poorly localized in the sacrospinalis muscle. The purpose of this work was to provide a more accurate anatomic description of this spinal approach and to describe anatomic landmarks to facilitate execution of the procedure. Material and methods: Fifty anatomic specimens were dissected (27 male and 23 female cadavers); 33 had been embalmed. The anatomy study used a bilateral approach to the spine. The exact anatomic localization of the muscle cleavage was noted. Measures were taken in relation to the mid line of the L4 spinatus process. Results: In all specimens, the muscle cleavage lay between the multifidus and longissimus heads of the sacrospinalis muscle. A fibrous partition was noted ...
segment length, and T1-12 height. Results: There were five females and five males with an average... more segment length, and T1-12 height. Results: There were five females and five males with an average age of 8+4 (5+7-14+5). Initial Cobb angle averaged 67.6 degrees (47-93) with an average operative correction of 61% (22-90%). Average follow-up was 28 months. Initial post-operative correction on average of 41 degrees (61%) was achieved. The Cobb angle had an average progression of 2.39 degrees/year (8 degrees correction/year-10 degrees progression/year), with an average final Cobb angle of 31.4 degrees (4-52). Most importantly, the intercalary segment grew, on average, 0.26 mm per vertebral body per year. The overall average growth achieved was 2.94 cm. There were two cases of superficial skin infection and one case requiring revision for prominent implant. Conclusion: This initial experience with the MLTC is encouraging. It shows the intercalary segment is indeed growing, while the Cobb angle is being controlled and repeated surgical procedures are being avoided. Further investigation into the effects on the sagittal profile, longevity of the implants, and comparison to other treatment options will be interesting moving forward.
Cualquier escoliosis evolutiva debe tratarse de modo eficaz. La fisioterapia es útil pero por sí ... more Cualquier escoliosis evolutiva debe tratarse de modo eficaz. La fisioterapia es útil pero por sí sola resulta insuficiente. El tratamiento ortopédico mediante corsé permite hacer más lento el empeoramiento de la deformación. En caso de fracaso o de dificultades relacionadas con el cumplimiento por parte del paciente, la evolución de la deformación puede hacer que, a partir de la adolescencia, o a más largo plazo, en la edad adulta, ésta se vuelva inaceptable. En este caso resulta necesario proponer un tratamiento quirúrgico con una instrumentación que permita la corrección de la deformación y un injerto óseo que asegure su estabilización. Estas intervenciones, practicadas de acuerdo con normas estrictas, proporcionan resultados satisfactorios y permiten una vida totalmente normal, a condición de que se mantenga una movilidad lumbar residual suficiente.
Le traitement chirurgical des deformations orthopediques secondaires a une infirmite motrice d’or... more Le traitement chirurgical des deformations orthopediques secondaires a une infirmite motrice d’origine cerebrale (IMOC) a considerablement evolue depuis une dizaine d’annees. L'apport des donnees de physiologie de l’ensemble musculo-tendineux [1], l'analyse instrumentale (EMG, cinematique, cinetique) venant completer les donnees de l’examen clinique, l'amelioration des suites operatoires par l’utilisation d’antalgiques et de decontracturants appropries et l'integration du traitement chirurgical dans un ensemble orthopedique comprenant la reeducation et un appareillage adequat ont contribue a l’amelioration des resultats des traitements chirurgicaux. Nous envisagerons les differentes attitudes vicieuses ou deformations rencontrees en insistant sur leur mecanisme de production et les possibilites therapeutiques medicales ou chirurgicales [2].
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