Factors associated with pelvic asymmetry in transverse plane during gait in patients with cerebral palsy

• Published in: Journal of pediatric orthopaedics. B Vol. 18; no. 6; pp. 320 - 324
• Main Authors: de Morais Filho, Mauro César, Kawamura, Cátia Myuki, Andrade, Paula Horta, dos Santos, Márcia Belas, Pickel, Marina Rigolin, Neto, Raul Bolliger
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins, Inc 01-11-2009
• Subjects: Adolescent; Biomechanical Phenomena; Cerebral Palsy - complications; Cerebral Palsy - pathology; Cerebral Palsy - physiopathology; Child; Child, Preschool; Female; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - pathology; Gait Disorders, Neurologic - physiopathology; Hemiplegia - etiology; Hemiplegia - pathology; Hemiplegia - physiopathology; Hip Joint - physiopathology; Humans; Knee Joint - physiopathology; Male; Pelvis - pathology; Pelvis - physiopathology; Range of Motion, Articular; Reference Values; Retrospective Studies
• ISSN: 1060-152X; 1473-5865
• DOI: 10.1097/BPB.0b013e32832e9599

The purpose of this study was to describe the patterns of pelvic rotational asymmetry in the transverse plane and identify the possible factors related to this problem. One thousand and forty-five patients with cerebral palsy (CP) and complete documentation in the gait laboratory were reviewed in a retrospective study. Pelvic asymmetry in the transverse plane was observed in 52.7% of the patients; and to identify the possible causes of pelvic retraction, clinical (Thomas test, popliteal angle, and gastrocnemius tightness) and dynamic parameters (mean rotation of the hip in stance, minimum hip flexion, minimum knee flexion, and peak ankle dorsiflexion) were evaluated. The association between these parameters and pelvic retraction was assessed statistically. The results showed that 75.7% of patients with asymmetric pattern of the pelvis had clinical diagnosis of diplegic spastic CP. Among the patients with asymmetrical CP, the most common pattern was pelvic retraction on the affected side. The relationship between pelvic retraction and internal hip rotation was stronger in patients with asymmetrical diplegic CP than in those with hemiplegic (P<0.001) or symmetrical diplegic CP (P = 0.014). All of the patients exhibited a significant association among clinical parameters (Thomas test, popliteal angle, and gastrocnemius tightness) and pelvic retraction. In conclusion, pelvic retraction seems to be a multifactorial problem, and the etiology can change according to topographic classification, which must be taken into account during the decision-making process in patients with CP.