Background: Severe crouch gait in patients with spastic diplegia
causes excessive loading of the patellofemoral joint and may result in
anterior knee pain, gait deterioration, and progressive loss of function.
Multilevel orthopaedic surgery has been used to correct severe crouch gait,
but no cohort studies or long-term results have been reported, to our
Methods: In order to be eligible for the present retrospective
cohort study, a patient had to have a severe crouch gait, as defined by
sagittal plane kinematic data, that had been treated with multilevel
orthopaedic surgery as well as a complete clinical, radiographic, and
instrumented gait analysis assessment. The surgical intervention consisted of
lengthening of contracted muscle-tendon units and correction of osseous
deformities, followed by the use of ground-reaction ankle-foot orthoses until
stable biomechanical realignment of the lower limbs during gait was achieved.
Outcome at one and five years after surgery was determined with use of
selected sagittal plane kinematic and kinetic parameters and valid and
reliable scales of functional mobility. Knee pain was recorded with use of a
Likert scale, and all patients had radiographic examination of the knees.
Results: Ten subjects with severe crouch gait and a mean age of 12.0
years at the time of surgery were studied. After surgery, the patients walked
in a more extended posture, with increased extension at the hip and knee and
reduced dorsiflexion at the ankle. Pelvic tilt increased, and normalized
walking speed was unaltered. Knee pain was diminished, and patellar fractures
and avulsion injuries healed. Improvements in functional mobility were found,
and, at the time of the five-year follow-up, fewer patients required the use
of wheelchairs or crutches in the community than had been the case prior to
Conclusions: Multilevel orthopaedic surgery for older children and
adolescents with severe crouch gait is effective for relieving stress on the
knee extensor mechanism, reducing knee pain, and improving function and
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.