Innovative method to treat patella alta in a patient with spastic cerebral palsy: a case report with literature review
Patella alta is a common condition in ambulatory patients with cerebral palsy, especially those with crouch gait. The treatment of symptomatic patella alta in such patients is complex and conservative methods seldom provide satisfactory results. Thus, patellar tendon advancement surgery is often req...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Sestre Milosrdnice University hospital, Institute of Clinical Medical Research
2023-01-01
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| Series: | Acta Clinica Croatica |
| Subjects: | |
| Online Access: | https://hrcak.srce.hr/file/447662 |
| _version_ | 1797206244976492544 |
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| author | Ivan Levaj Ivan Bohaček Tomislav Đapić Domagoj Delimar |
| author_facet | Ivan Levaj Ivan Bohaček Tomislav Đapić Domagoj Delimar |
| author_sort | Ivan Levaj |
| collection | DOAJ |
| description | Patella alta is a common condition in ambulatory patients with cerebral palsy, especially those with crouch gait. The treatment of symptomatic patella alta in such patients is complex and conservative methods seldom provide satisfactory results. Thus, patellar tendon advancement surgery is often required and can be, if necessary, combined with other surgical procedures. Here, we report a case of combining both conservative method and surgical procedure in a 26-year-old female patient with cerebral palsy and bilateral patella alta. One month prior to surgical intervention we administered a botulinum toxin type A (BTX-A) in the ipsilateral quadriceps. Reduced muscle spasticity of the knee extensor mechanism facilitated the patellar tendon shortening procedure and yielded excellent postoperative results. After a six-month postoperative rehabilitation course, the patient had no pain and the knee range of motion improved from 5-50° preoperatively to 0-140° postoperatively in both knees. To our knowledge, we are the first to report a use of preoperative BTX-A in the treatment of patella alta in a patient with cerebral palsy. The efficacy and safety of this treatment modality may give encouragement to a wider use of preoperative BTX-A in order to facilitate surgical intervention and postoperative rehabilitation in cases of muscle spasticity. |
| first_indexed | 2024-04-24T09:03:57Z |
| format | Article |
| id | doaj.art-6b9e4bfcbc3e44f39c09fc248d3e936d |
| institution | Directory Open Access Journal |
| issn | 0353-9466 1333-9451 |
| language | English |
| last_indexed | 2024-04-24T09:03:57Z |
| publishDate | 2023-01-01 |
| publisher | Sestre Milosrdnice University hospital, Institute of Clinical Medical Research |
| record_format | Article |
| series | Acta Clinica Croatica |
| spelling | doaj.art-6b9e4bfcbc3e44f39c09fc248d3e936d2024-04-15T19:05:50ZengSestre Milosrdnice University hospital, Institute of Clinical Medical ResearchActa Clinica Croatica0353-94661333-94512023-01-0162.Supplement 311512010.20471/acc.2023.62.s3.15Innovative method to treat patella alta in a patient with spastic cerebral palsy: a case report with literature reviewIvan Levaj0Ivan Bohaček1Tomislav Đapić2Domagoj Delimar3Department of Orthopaedic Surgery, University Hospital Centre Zagreb, Zagreb, CroatiaDepartment of Orthopaedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia; 2 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, CroatiaDepartment of Orthopaedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia; 2 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, CroatiaDepartment of Orthopaedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia; 2 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, CroatiaPatella alta is a common condition in ambulatory patients with cerebral palsy, especially those with crouch gait. The treatment of symptomatic patella alta in such patients is complex and conservative methods seldom provide satisfactory results. Thus, patellar tendon advancement surgery is often required and can be, if necessary, combined with other surgical procedures. Here, we report a case of combining both conservative method and surgical procedure in a 26-year-old female patient with cerebral palsy and bilateral patella alta. One month prior to surgical intervention we administered a botulinum toxin type A (BTX-A) in the ipsilateral quadriceps. Reduced muscle spasticity of the knee extensor mechanism facilitated the patellar tendon shortening procedure and yielded excellent postoperative results. After a six-month postoperative rehabilitation course, the patient had no pain and the knee range of motion improved from 5-50° preoperatively to 0-140° postoperatively in both knees. To our knowledge, we are the first to report a use of preoperative BTX-A in the treatment of patella alta in a patient with cerebral palsy. The efficacy and safety of this treatment modality may give encouragement to a wider use of preoperative BTX-A in order to facilitate surgical intervention and postoperative rehabilitation in cases of muscle spasticity.https://hrcak.srce.hr/file/447662patellapatellar ligamentcerebral palsyspasticitybotulinum toxins |
| spellingShingle | Ivan Levaj Ivan Bohaček Tomislav Đapić Domagoj Delimar Innovative method to treat patella alta in a patient with spastic cerebral palsy: a case report with literature review Acta Clinica Croatica patella patellar ligament cerebral palsy spasticity botulinum toxins |
| title | Innovative method to treat patella alta in a patient with spastic cerebral palsy: a case report with literature review |
| title_full | Innovative method to treat patella alta in a patient with spastic cerebral palsy: a case report with literature review |
| title_fullStr | Innovative method to treat patella alta in a patient with spastic cerebral palsy: a case report with literature review |
| title_full_unstemmed | Innovative method to treat patella alta in a patient with spastic cerebral palsy: a case report with literature review |
| title_short | Innovative method to treat patella alta in a patient with spastic cerebral palsy: a case report with literature review |
| title_sort | innovative method to treat patella alta in a patient with spastic cerebral palsy a case report with literature review |
| topic | patella patellar ligament cerebral palsy spasticity botulinum toxins |
| url | https://hrcak.srce.hr/file/447662 |
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