ki hyuk sung, md
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Relationship between rotational gait parameters and torsional bony deformities in patients with diplegic cerebral palsy. Ki Hyuk Sung, MD. Seoul National University Bundang Hospital. Introduction. - PowerPoint PPT PresentationTRANSCRIPT
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Ki Hyuk Sung, MD
Relationship between rotational gait parameters and torsional bony
deformities in patients with diplegic cerebral palsy
Seoul National University Bundang Hospital
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SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL
Introduction
• Intoeing gait is a common gait problem in patients with diplegic CP, which affects gait efficacy and cosmesis.
• Femoral anteversion and tibial torsion are usually focuses of attention in evaluation and treatment.
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SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL
Introduction
• However, there might be other structural problem affecting rotational gait parameters.
• In some clinical situation, degree of femoral anteversion and tibial torsion do not necessarily reflect the severity of the rotational gait problems.
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SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL
Purpose of the study
• To investigate comprehensively relationships between rotational gait parameters and torsional bony alignment, including different deformity types, in patients with diplegic CP
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SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL
Materials and Methods
• Retrospective design
• Inclusion
– Ambulatory patients with diplegic CP
– 3D gait analysis
– Torsional CT
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SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL
3D gait parameters
• Mean foot progression angle in stance
• Mean hip rotation
• Mean tibia rotation
• Mean pelvic rotation
• Adjusted foot progression angle
– Foot progression angle – pelvic rotation
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SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL ◦ SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL
Radiographic measurements
• Acetabular version on CT
• Femoral anteversion on CT
• Tibial torsion on CT
• Knee torsion on CT
• AP talo-1st metatarsal angle on
weightbearing AP foot radiographs
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Acetabular version
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Femoral anteversion
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Knee torsion
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Tibial torsion
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AP talo-1st metatarsal angle
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Reliability of radiographic measurement
• 2 orthopaedic surgeons, 15 patients
• ICC (intraclass correlation coefficient)
& MAD (mean absolute difference)
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Relation btw radiographic measurements & gait parameters
• Pearson’s correlation coefficient
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Multiple regression anlysis
• Structural torsional deformities (CT and
radiographic measurements) significantly
contributing to adjusted foot progression
angle
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Results
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Conclusions
• Adjusted foot pregression angle was more
relevant than foot progression angle.
• Femoral anteversion and tibial torsion
were found to be the significant structural
deformities that affect adjusted foot
progression angle
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Conclusions
• However, femoral anteversion and tibial
torsion were found to explain only 24.7%
of adjusted foot progression angle
• Other structural factors or muscle balance
need to be considered.
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Thank you !