{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:29:21Z","timestamp":1790634561578,"version":"4.1.0"},"reference-count":26,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T00:00:00Z","timestamp":1616457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>This article presents a classification of lower limb musculoskeletal pathology (MSP) for ambulant children with cerebral palsy (CP) to identify key features from infancy to adulthood. The classification aims to improve communication, and to guide referral for interventions, which if timed appropriately, may optimise long-term musculoskeletal health and function. Consensus was achieved by discussion between staff in a Motion Analysis Laboratory (MAL). A four-stage classification system was developed: Stage 1: Hypertonia: Abnormal postures are dynamic. Stage 2: Contracture: Fixed shortening of one or more muscle-tendon units. Stage 3: Bone and joint deformity: Torsional deformities and\/or joint instability (e.g., hip displacement or pes valgus), usually accompanied by contractures. Stage 4: Decompensation: Severe pathology where restoration of optimal joint and muscle-tendon function is not possible. Reliability of the classification was tested using the presentation of 16 clinical cases to a group of experienced observers, on two occasions, two weeks apart. Reliability was found to be very good to excellent, with mean Fleiss\u2019 kappa ranging from 0.72 to 0.84. Four-stages are proposed to classify lower limb MSP in children with CP. The classification was reliable in a group of clinicians who work together. We emphasise the features of decompensated MSP in the lower limb, which may not always benefit from reconstructive surgery and which can be avoided by timely intervention.<\/jats:p>","DOI":"10.3390\/children8030252","type":"journal-article","created":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T14:08:16Z","timestamp":1616508496000},"page":"252","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study"],"prefix":"10.3390","volume":"8","author":[{"given":"H. Kerr","family":"Graham","sequence":"first","affiliation":[{"name":"Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia"},{"name":"Hugh Williamson Gait Laboratory, Royal Children\u2019s Hospital, Parkville, VIC 3052, Australia"},{"name":"Murdoch Children\u2019s Research Institute, Parkville, VIC 3052, Australia"},{"name":"Orthopaedic Department, The Royal Children\u2019s Hospital, Parkville, VIC 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0173-9037","authenticated-orcid":false,"given":"Pam","family":"Thomason","sequence":"additional","affiliation":[{"name":"Hugh Williamson Gait Laboratory, Royal Children\u2019s Hospital, Parkville, VIC 3052, Australia"},{"name":"Murdoch Children\u2019s Research Institute, Parkville, VIC 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Willoughby","sequence":"additional","affiliation":[{"name":"Murdoch Children\u2019s Research Institute, Parkville, VIC 3052, Australia"},{"name":"Orthopaedic Department, The Royal Children\u2019s Hospital, Parkville, VIC 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tandy","family":"Hastings-Ison","sequence":"additional","affiliation":[{"name":"Hugh Williamson Gait Laboratory, Royal Children\u2019s Hospital, Parkville, VIC 3052, Australia"},{"name":"Murdoch Children\u2019s Research Institute, Parkville, VIC 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee Van","family":"Stralen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Sophia Children\u2019s Hospital, Erasmus MC, 3015GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benan","family":"Dala-Ali","sequence":"additional","affiliation":[{"name":"Orthopaedic Department, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wong","sequence":"additional","affiliation":[{"name":"Hugh Williamson Gait Laboratory, Royal Children\u2019s Hospital, Parkville, VIC 3052, Australia"},{"name":"Orthopaedic Department, The Royal Children\u2019s Hospital, Parkville, VIC 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2292-0946","authenticated-orcid":false,"given":"Erich","family":"Rutz","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia"},{"name":"Hugh Williamson Gait Laboratory, Royal Children\u2019s Hospital, Parkville, VIC 3052, Australia"},{"name":"Murdoch Children\u2019s Research Institute, Parkville, VIC 3052, Australia"},{"name":"Orthopaedic Department, The Royal Children\u2019s Hospital, Parkville, VIC 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,23]]},"reference":[{"key":"ref_1","unstructured":"Morrissy, R.T. 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