Functional and Gait Outcomes After Distal Femoral Extension/Shortening Osteotomy With Patellar Tendon Advancement in Cerebral Palsy: Coronal Knee Alignment in a Tertiary Center Study Publisher



Soleymani M ; Safaei H ; Valadkhani C ; Metanat S ; Sadeghi M ; Presedo A ; Nabian M H
Source: Journal of Bodywork and Movement Therapies Published:2026

Abstract

Introduction Crouch gait, marked by excessive knee flexion, impairs mobility and quality of life (QoL) in cerebral palsy (CP). This study evaluated outcomes of distal femoral extension/shortening osteotomy (DFEO/DFSO) with patellar tendon advancement (PTA). Methods Fifteen patients (30 limbs; 29 analyzed) with spastic diplegic CP and crouch gait (GMFCS II–III) underwent DFEO/DFSO + PTA in this prospective study. Pre- and postoperative assessments included gait analysis, radiology, physical examination, and patient-reported outcomes. Results Knee extension deficit improved markedly (25.7° to 1.5°, p < 0.001). Functional Mobility Scale scores improved across all distances (p ≤ 0.002), and QoL scores increased significantly. Postoperative coronal alignment was not associated with functional outcomes; however, limbs achieving near-normal alignment (5°–7° valgus) demonstrated significantly reduced ankle dorsiflexion during stance compared with malaligned limbs. CPQOL scores improved from 50 ± 11 to 66 ± 10 (p < 0.001). Complications included peroneal nerve injury (6.9%) and tibial tuberosity fracture (3.4%). Conclusion DFEO/DFSO + PTA significantly improved knee mechanics, gait, and patient-reported well-being in CP patients with crouch gait. Postoperative coronal alignment variability did not correlate with overall functional outcomes; however, near-normal alignment was associated with reduced ankle dorsiflexion during stance, suggesting a potential biomechanical link. © 2026 Elsevier Ltd.