{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T08:57:35Z","timestamp":1782377855636,"version":"3.54.5"},"reference-count":83,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Children's Orthopaedics"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>A majority of ambulant children with cerebral palsy (CP) develop progressive musculoskeletal pathology (MSP) during growth. Fixed flexion deformity at the knee joint (FFDKn) contributes to flexed knee gait and is prone to relapse after index multi-level surgery. This perspective introduces the concept of \u201cknee surveillance\u201d (KS), defined as a repeated systematic assessment of gait and knee range of motion until skeletal maturity. KS aims to detect early FFDKn, allowing for early intervention with minimally invasive techniques such as anterior distal femur hemiepiphysiodesis (ADFH), and reduce the need for higher-risk surgery such as distal femoral extension osteotomy (DFEO) and patellar tendon shortening (PTS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Recent literature on the assessment of ambulant children with CP, consensus statements on indications for dose-based knee surgery, and the indications for ADFH have been reviewed and synthesized. These provide a preliminary evidence base for the concept of KS in ambulant children with CP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>We propose the concept of KS for ambulant children with CP. The goals of KS are early detection of knee flexion deformity, early intervention, less invasive surgery, and better long-term outcomes. There is preliminary evidence to suggest that soft-tissue surgery, in combination with ADFH, can reduce, or perhaps replace, the need for more invasive surgery such as DFEO and PTS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence:<\/jats:title>\n                    <jats:p>IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/18632521251330448","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T14:27:17Z","timestamp":1744727237000},"page":"253-266","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Knee surveillance for ambulant children with cerebral palsy"],"prefix":"10.1177","volume":"19","author":[{"given":"Pam","family":"Thomason","sequence":"first","affiliation":[{"name":"The Hugh Williamson Gait Laboratory, The Royal Children\u2019s Hospital, Parkville, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerr","family":"Graham","sequence":"additional","affiliation":[{"name":"The Hugh Williamson Gait Laboratory, The Royal Children\u2019s Hospital, Parkville, VIC, Australia"},{"name":"The University of Melbourne, Parkville, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Ye","sequence":"additional","affiliation":[{"name":"The Hugh Williamson Gait Laboratory, The Royal Children\u2019s Hospital, Parkville, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"O\u2019Donnell","sequence":"additional","affiliation":[{"name":"The Hugh Williamson Gait Laboratory, The Royal Children\u2019s Hospital, Parkville, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedant","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Shriners Children\u2019s, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1639-6519","authenticated-orcid":false,"given":"Jon R.","family":"Davids","sequence":"additional","affiliation":[{"name":"Shriners Children\u2019s, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erich","family":"Rutz","sequence":"additional","affiliation":[{"name":"The Hugh Williamson Gait Laboratory, The Royal Children\u2019s Hospital, Parkville, VIC, Australia"},{"name":"Bob Dickens Chair Paediatric Orthopaedic Surgery, Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.82"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511544866.013"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.85B2.14066"},{"key":"e_1_3_2_5_2","first-page":"105","volume-title":"Management of the motor disorders of children with cerebral palsy","author":"Graham HK.","year":"2004","unstructured":"Graham HK. 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