Foot and ankle compensation for anterior cruciate ligament deficiency during gait in children.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are common in adults and cause knee instability, pain, and an increased risk of osteoarthritis. Previous studies demonstrated changed gait patterns in adult patients with ACL deficiency. In paediatric patients, ACL injuries were once thought to be rare but are being increasingly diagnosed due to greater involvement of children in contact sports and to the introduction of more effective diagnostic tools such as magnetic resonance imaging (MRI). However, little is known about gait adaptation in children with ACL deficiency. The objective of this study was to look for compensatory foot and ankle behaviours during gait in paediatric patients with symptomatic ACL deficiency. HYPOTHESIS: Compensation for ACL deficiency during gait occurs at the foot and ankle in children, because compensation at the hip and pelvis would require greater energy expenditure. MATERIAL AND METHODS: We included 47 patients, 33 males and 14 females, ranging in age from 9 to 17 years (mean, 14.1 years). The patients had a history of unilateral ACL injury documented by MRI and initially treated by immobilisation and physical therapy. They were allowed to walk with full weight-bearing on the affected limb and were not taking medications at the time of the study. All patients had pain, knee instability, or functional limitation. The physical examination showed joint laxity indicating surgical ACL reconstruction. None had neurological conditions, congenital musculoskeletal abnormalities, or a history of knee surgery. Gait analysis (GA) was performed using a Vicon 460 system. Kinematic data for the ankle and foot were compared to those in a control group of 37 healthy children. Ankle angular positions were calculated for each group at the following stance time points: initial contact (0% of gait cycle [GC]), mid-stance (25% GC), terminal stance (60% GC), and swing (83% GC). Foot progression data were recorded at mid-stance (25% GC) and swing (70% GC). Student's t test was applied to compare the results to reference values obtained at our laboratory and to data from the control group. RESULTS: Compared to the reference values, the ankle was in plantar flexion at initial contact in 41 patients, and ankle dorsiflexion during the stance phase was diminished in 39 patients. The external foot progression angle was increased in 23 patients during the stance phase and 38 patients during the swing phase. Compared to the control group (mean age, 9.1 years), the patients had plantar flexion of the ankle at initial contact (3.43°±3.5° vs. 0.74°±3.6°, p<0.05) and decreased dorsiflexion during the stance phase (3.43°±3.5° vs. 0.74°±3.6°, p<0.05). No significant differences were found for any of the other parameters. DISCUSSION: Children with ACL deficiency developed compensatory foot and ankle behaviours during gait that improved knee stability. Understanding these compensations may guide treatment optimisation. LEVEL OF EVIDENCE: III, retrospective comparative study.

Concordance for curve type in idiopathic scoliosis among family members / Concordância do tipo de curva em escoliose idiopática entre familiares

ABSTRACT OBJECTIVE: To evaluate the concordance for the curve pattern, side and levels of the superior apical vertebrae, apex and inferior apical vertebrae of curves in patients and their relatives with idiopathic scoliosis. METHODS: Concordance according to the Lenke classification for curve pattern, side and levels of the superior apical vertebrae, apex and inferior apical vertebrae were evaluated comparative and prospectively in 243 pairs of patients and respective relatives with idiopathic scoliosis. RESULTS: The family concordance for the curve pattern and side was 51.4% (125 pairs). Among these pairs, the concordance of the levels of the vertebrae was 91.2% (114 pairs). The concordance rate for the curve pattern and side between parents/children was 51.6% and between siblings was 50.0% (p-value= 0.411). The concordance rates of the levels of vertebrae were 86.8% and 95.1%, respectively (p-value = 0.219). CONCLUSION: Curve shape in idiopathic scoliosis is related to family and degree of kinship, since the data showed a high concordance for the curve pattern, side and levels of the apical vertebrae and apex between patients and relatives with this deformity. The concordance was higher in those with a closer degree of kinship. Level of Evidence II, Lesser Quality Prospective Study.

RESUMO OBJETIVO: Avaliar a concordância para o padrão de curva, lado e níveis das vértebras apical superior, ápex e apical inferior das curvas de pacientes e respectivos familiares com escoliose idiopática. MÉTODOS: A concordância, pela classificação de Lenke, para o padrão de curva, lado e níveis das vértebras apical superior, ápex e apical inferior foi avaliada em 243 pares de pacientes e respectivos familiares com escoliose idiopática. RESULTADOS: A concordância familiar para o padrão de curva e lado foi de 51,4% (125 pares). Entre esses pares, a concordância dos níveis das vértebras foi de 91,2% (114 pares). A taxa de concordância para o padrão de curva e lado entre pais/filhos foi de 51,6% e entre irmãos foi de 50,0% (p= 0,411). As taxas de concordância dos níveis das vértebras foram respectivamente de 86,8% e 95,1% (p-valor = 0,219). CONCLUSÃO: O formato das curvas na escoliose idiopática tem relação familiar e com o grau de parentesco, uma vez que se reportou alta concordância para o padrão de curva, lado e níveis das vértebras apicais e ápex entre pacientes e familiares com a deformidade. A concordância foi maior entre aqueles com grau de parentesco mais próximo. Nível de Evidência Ii, Estudo Prospectivo de Menor Qualidade.