{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T01:43:17Z","timestamp":1790991797323,"version":"4.1.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,1,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>We examined long-term outcomes across the domains of the International Classification of Functioning, Disability and Health for 2 groups of participants with cerebral palsy who demonstrated crouch gait at clinical gait analysis. One group underwent a distal femoral extension osteotomy with patellar tendon advancement (DFEO + PTA). The other group received other treatments (non-DFEO + PTA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Fifty-one participants returned for a long-term gait analysis, physical examination, energy consumption test, knee radiographs, and questionnaires (median, 13 years post-DFEO + PTA or post-baseline [range, 8 to 21 years]). A subset of participants in the DFEO + PTA group also had a short-term analysis (9 to 24 months postoperatively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Participants were reasonably well-matched at baseline, although the DFEO + PTA group demonstrated greater crouch: minimum knee flexion, a median of 37\u00b0 (width of the interquartile range, 12\u00b0) compared with 27\u00b0 (9\u00b0); and knee flexion contracture, a median of 15\u00b0 (10\u00b0) compared with 10\u00b0 (5\u00b0). The gait deviation index (GDI) and sagittal plane knee kinematics were most improved at short term for the DFEO + PTA participants, with a subsequent slight decline at long-term analysis. Fewer DFEO + PTA participants were in crouch at long term (37% compared with 65%). At the long-term assessment, group scores for function, mobility, participation, quality of life, and most pain questionnaires were similar. Knee pain and osteoarthritis ratings did not differ between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>At long-term analysis, DFEO + PTA improves stance phase knee extension and knee flexion contracture compared with conventional treatment, but these benefits do not translate to improved activity, participation, or knee pain in early adulthood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.17.00480","type":"journal-article","created":{"date-parts":[[2018,1,4]],"date-time":"2018-01-04T20:24:43Z","timestamp":1515097483000},"page":"31-41","source":"Crossref","is-referenced-by-count":66,"title":["Long-Term Outcomes of Distal Femoral Extension Osteotomy and Patellar Tendon Advancement in Individuals with Cerebral Palsy"],"prefix":"10.2106","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5448-179X","authenticated-orcid":false,"given":"Elizabeth R.","family":"Boyer","sequence":"first","affiliation":[{"name":"Gillette Children\u2019s Specialty Healthcare, St. Paul, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean L.","family":"Stout","sequence":"additional","affiliation":[{"name":"Gillette Children\u2019s Specialty Healthcare, St. Paul, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer C.","family":"Laine","sequence":"additional","affiliation":[{"name":"Gillette Children\u2019s Specialty Healthcare, St. Paul, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M.","family":"Gutknecht","sequence":"additional","affiliation":[{"name":"Gillette Children\u2019s Specialty Healthcare, St. Paul, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas H.","family":"Araujo de Oliveira","sequence":"additional","affiliation":[{"name":"Hospital da Baleia, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan E.","family":"Munger","sequence":"additional","affiliation":[{"name":"Gillette Children\u2019s Specialty Healthcare, St. Paul, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael H.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Gillette Children\u2019s Specialty Healthcare, St. Paul, Minnesota"},{"name":"University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom F.","family":"Novacheck","sequence":"additional","affiliation":[{"name":"Gillette Children\u2019s Specialty Healthcare, St. Paul, Minnesota"},{"name":"University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"1","key":"bib1-20230811","first-page":"79","article-title":"Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery","volume":"25","author":"Wren","year":"2005","journal-title":"J Pediatr Orthop."},{"issue":"1","key":"bib2-20230811","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/dmcn.13205","article-title":"Prevalence of specific gait abnormalities in children with cerebral palsy revisited: influence of age, prior surgery, and Gross Motor Function Classification System level","volume":"59","author":"Rethlefsen","year":"2017","journal-title":"Dev Med Child Neurol."},{"issue":"5","key":"bib4-20230811","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1097\/01241398-200209000-00020","article-title":"Natural progression of gait in children with cerebral palsy","volume":"22","author":"Bell","year":"2002","journal-title":"J Pediatr Orthop."},{"issue":"1","key":"bib5-20230811","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1002\/jor.1100140123","article-title":"Hamstrings and psoas lengths during normal and crouch gait: implications for muscle-tendon surgery","volume":"14","author":"Delp","year":"1996","journal-title":"J Orthop Res."},{"issue":"3","key":"bib6-20230811","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.gaitpost.2005.03.003","article-title":"The role of estimating muscle-tendon lengths and velocities of the hamstrings in the evaluation and treatment of crouch gait","volume":"23","author":"Arnold","year":"2006","journal-title":"Gait Posture."},{"issue":"2","key":"bib7-20230811","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1302\/0301-620X.67B2.3980536","article-title":"Avulsion of the distal pole of the patella in cerebral palsy. 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