Single-event multilevel surgery, but not botulinum toxin injections normalize joint loading in cerebral palsy patients

S Van Rossom; H Kainz; M Wesseling; E Papageorgiou; F De Groote; A Van Campenhout; G Molenaers; K Desloovere; I Jonkers

doi:10.1016/j.clinbiomech.2020.105025

Single-event multilevel surgery, but not botulinum toxin injections normalize joint loading in cerebral palsy patients

Clin Biomech (Bristol, Avon). 2020 Jun:76:105025. doi: 10.1016/j.clinbiomech.2020.105025. Epub 2020 May 1.

Authors

S Van Rossom¹, H Kainz², M Wesseling³, E Papageorgiou⁴, F De Groote⁵, A Van Campenhout⁶, G Molenaers⁷, K Desloovere⁸, I Jonkers⁹

Affiliations

¹ Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium. Electronic address: sam.vanrossom@kuleuven.be.
² Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium; University of Vienna Centre for Sport Science and University Sports Department of Biomechanics, Kinesiology and Computer Science, Austria. Electronic address: hans.kainz@kuleuven.be.
³ Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium. Electronic address: mariska.wesseling@kuleuven.be.
⁴ Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium. Electronic address: eirini.papageorgiou@kuleuven.be.
⁵ Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium. Electronic address: friedl.degroote@kuleuven.be.
⁶ Organ Systems, Department of Development and Regeneration, KU Leuven, Belgium; Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium. Electronic address: anja.vancampenhout@uzleuven.be.
⁷ Organ Systems, Department of Development and Regeneration, KU Leuven, Belgium; Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium. Electronic address: guy.molenaers@uzleuven.be.
⁸ Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium. Electronic address: kaat.desloovere@uzleuven.be.
⁹ Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium. Electronic address: ilse.jonkers@kuleuven.be.

PMID: 32402900
DOI: 10.1016/j.clinbiomech.2020.105025

Abstract

Background: Many patients with cerebral palsy present a pathologic gait pattern, which presumably induces aberrant musculoskeletal loading that interferes with natural bone growth, causing bone deformations on the long term. Botulinum toxin interventions and single-event multilevel surgeries are used to restore the gait pattern, assuming that a normal gait pattern restores musculoskeletal loading and thus prevents further bone deformation. However, it is unknown if these interventions are able to restore musculoskeletal loading. Hence, we investigated the impact of botulinum toxin injections and single-event multilevel surgery on musculoskeletal loading.

Methods: Gait data collected in 93 children with bilateral cerebral palsy, which included pre- and post multi-level botulinum toxin (49 children) and single-event multilevel surgery (44 children) assessments, and 15 typically developing children were retrospectively processed using a musculoskeletal modelling workflow to calculate joint angles, moments, muscle and joint contact force magnitudes and orientations. Differences from the typically developing waveform were expressed by a root-mean square difference were compared using paired t-tests for each intervention separately (alpha <0.05).

Findings: Botulinum toxin induced significant changes in the joint angles, but did not improve the muscle and joint contact forces. Single-event multilevel surgery induced significant kinematic and kinetic changes, which were associated with improved muscle and joint contact forces.

Interpretation: The present results indicate that botulinum toxin injections were not able to restore normal gait kinematics nor musculoskeletal loading, whereas single-event multilevel surgery did successfully restore both. Therefore, single-event multilevel surgery might be protective against the re-occurrence of bone deformation on the longer term.

Keywords: Botox; Cerebral palsy; Gait; Joint loading; Single-event multilevel surgery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomechanical Phenomena / drug effects
Botulinum Toxins, Type A / pharmacology
Cerebral Palsy / physiopathology*
Cerebral Palsy / surgery*
Child
Child, Preschool
Female
Gait / drug effects
Gait / physiology
Humans
Joints / drug effects
Joints / physiopathology*
Male
Orthopedic Procedures*
Retrospective Studies
Treatment Outcome
Weight-Bearing

Substances

Botulinum Toxins, Type A