{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:40:35Z","timestamp":1765212035526,"version":"3.46.0"},"reference-count":42,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009389","name":"PROMOBILIA","doi-asserted-by":"publisher","award":["F23183"],"award-info":[{"award-number":["F23183"]}],"id":[{"id":"10.13039\/100009389","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: There is limited information on the interplay between passive joint motion and joint kinematics from three-dimensional gait analysis (3DGA) and its longitudinal evolution in cerebral palsy (CP). We aimed to associate clinical measurements and gait kinematics over time using a longitudinal study design. Methods: Ambulatory individuals with spastic CP, aged 4\u201318, who performed a minimum of two 3DGA at the Karolinska University Hospital between 2008 and 2025 were recruited. Primary outcomes were sagittal plane kinematics and maximum passive knee extension (pKE). Canonical correlation (R) with statistical parametric mapping was used to associate passive maximum knee extension with sagittal hip, knee, and ankle angles at two timepoints. Results: the 3DGA data of 31 children (age 4\u201317 years; mean age 10.4 +\/\u2212 2.9) with 22 bilateral (bCP, GMFCS I = 6; II = 13; III = 3) and 9 unilateral CP (uCP, GMFCS I = 8; II = 1) was included. For the whole and bCP groups, respectively, knee flexion\/extension and pKE were correlated throughout stance (p &lt; 0.001), with R between \u22120.47 and \u22120.57\/\u22120.49 and \u22120.59 at T1 and between \u22120.46 and \u22120.72\/\u22120.50 and \u22120.76 at T2. Hip flexion\/extension and knee pKE were correlated from 17 to 62%\/46\u201352% of the gait cycle (p &lt; 0.001\/p = 0.045) for the whole and bCP groups, respectively, with R between \u22120.41 and \u22120.57\/\u22120.38 and \u22120.41 at T1 and from 15 to 64%\/17 to 61% with R between \u22120.50 and \u22120.57\/\u22120.42 and \u22120.57 at T2. Conclusions: Reported associations between structural knee properties and knee position during gait demonstrated progression over time, implying that a restricted range of motion may be driven by functional constraints. Combining knee contractures and their longitudinal development with 3DGA is a powerful approach for pre-intervention planning.<\/jats:p>","DOI":"10.3390\/jcm14238567","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:20:29Z","timestamp":1765210829000},"page":"8567","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations Between Maximal Passive Knee Extension and Sagittal Plane Kinematic Patterns in Children with Spastic Cerebral Palsy: A Longitudinal Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8695-0095","authenticated-orcid":false,"given":"Inti","family":"Vanmechelen","sequence":"first","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Karolinska Institutet, 171 76 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edwin","family":"R\u00e5sberg","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Karolinska Institutet, 171 76 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2967-8080","authenticated-orcid":false,"given":"Eva","family":"Brostr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Karolinska Institutet, 171 76 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5467-0056","authenticated-orcid":false,"given":"Cecilia","family":"Lidbeck","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Karolinska Institutet, 171 76 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/j.1469-8749.2007.tb12610.x","article-title":"A report: The definition and classification of cerebral palsy April 2006","volume":"49","author":"Rosenbaum","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.ejpn.2006.12.010","article-title":"Bilateral spastic cerebral palsy\u2014Prevalence through four decades, motor function and growth","volume":"11","author":"Himmelmann","year":"2007","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1111\/j.1469-8749.2000.tb00695.x","article-title":"Surveillance of cerebral palsy in Europe: A collaboration of cerebral palsy surveys and registers","volume":"42","author":"Cans","year":"2000","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1055\/s-0040-1701669","article-title":"Severity of Cerebral Palsy-The Impact of Associated Impairments","volume":"51","author":"Horber","year":"2020","journal-title":"Neuropediatrics"},{"key":"ref_5","first-page":"75","article-title":"Walking Ability, Participation, and Quality of Life in Children with Spastic Diplegic Cerebral Palsy: A Path Analysis Study","volume":"17","author":"Vameghi","year":"2023","journal-title":"Iran. J. Child. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1111\/cch.13055","article-title":"Health-related quality of life in adolescents with cerebral palsy; a cross-sectional and longitudinal population-based study","volume":"49","author":"Larsen","year":"2023","journal-title":"Child Care Health Dev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.jos.2022.08.011","article-title":"Relationship between spatiotemporal parameters and clinical outcomes in children with bilateral spastic cerebral palsy: Clinical interpretation proposal","volume":"28","author":"Martori","year":"2023","journal-title":"J. Orthop. Sci."},{"key":"ref_8","first-page":"560","article-title":"Gait analysis: Clinical facts","volume":"52","author":"Baker","year":"2016","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1097\/PEP.0000000000001101","article-title":"Three-Dimensional Instrumented Gait Analysis for Children With Cerebral Palsy: An Evidence-Based Clinical Practice Guideline","volume":"36","author":"States","year":"2024","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Schwartz, M.H., Ries, A.J., Georgiadis, A.G., and Kainz, H. (2024). Demonstrating the utility of Instrumented Gait Analysis in the treatment of children with cerebral palsy. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0301230"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.gaitpost.2015.07.003","article-title":"Long-term outcomes after multilevel surgery including rectus femoris, hamstring and gastrocnemius procedures in children with cerebral palsy","volume":"42","author":"Solomito","year":"2015","journal-title":"Gait Posture"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fehlings, D., Bohn, E., Switzer, L., Goldsmith, C.H., Narayanan, U., Rosenbaum, P.L., Wright, F.V., and Foster, G. (2025). Three-year outcomes of repeated botulinum neurotoxin A injections to the lower extremities in young children with spastic cerebral palsy in GMFCS levels I to III. Dev. Med. Child Neurol., in press.","DOI":"10.1111\/dmcn.70031"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Pyrzanowska, W., Chro\u015bci\u0144ska-Krawczyk, M., and Bonikowski, M. (2025). Long-Term Improvement of Gait Kinematics in Young Children with Cerebral Palsy Treated with Botulinum Toxin Injections and Integrated\/Intensive Rehabilitation: A 5-Year Retrospective Observational Study. Toxins, 17.","DOI":"10.3390\/toxins17030142"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.ejpn.2024.02.017","article-title":"Botulinum neurotoxin type A responders among children with spastic cerebral palsy: Pattern-specific effects","volume":"49","author":"Papageorgiou","year":"2024","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.gaitpost.2005.10.008","article-title":"Do dynamic and static clinical measurements correlate with gait analysis parameters in children with cerebral palsy?","volume":"24","author":"Desloovere","year":"2006","journal-title":"Gait Posture"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1097\/01241398-200005000-00018","article-title":"Correlation of static to dynamic measures of lower extremity range of motion in cerebral palsy and control populations","volume":"20","author":"McMulkin","year":"2000","journal-title":"J. Pediatr. Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.jelekin.2014.10.015","article-title":"Decrease in ankle-foot dorsiflexion range of motion is related to increased knee flexion during gait in children with spastic cerebral palsy","volume":"25","author":"Maas","year":"2015","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Manikowska, F., Brazevi\u010d, S., J\u00f3\u017awiak, M., and Lebiedowska, M.K. (2022). Contribution of Different Impairments to Restricted Knee Flexion during Gait in Individuals with Cerebral Palsy. J. Pers. Med., 12.","DOI":"10.3390\/jpm12101568"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"81","DOI":"10.12688\/hrbopenres.13647.1","article-title":"A prospective assessment of gait kinematics and related clinical examination measures in cerebral palsy crouch gait","volume":"5","author":"French","year":"2022","journal-title":"HRB Open Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.gaitpost.2022.04.018","article-title":"Age related progression of clinical measures and gait in ambulant children and youth with bilateral cerebral palsy without a history of surgical intervention","volume":"95","author":"Daly","year":"2022","journal-title":"Gait Posture"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1016\/j.jbiomech.2016.03.032","article-title":"The probability of false positives in zero-dimensional analyses of one-dimensional kinematic, force and EMG trajectories","volume":"49","author":"Pataky","year":"2016","journal-title":"J. Biomech."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Papageorgiou, E., Simon-Martinez, C., Molenaers, G., Ortibus, E., Campenhout, A., and Desloovere, K. (2019). Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0223363"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"200","DOI":"10.2340\/17453674.2024.40606","article-title":"Knee and ankle range of motion and spasticity from childhood into adulthood: A longitudinal cohort study of 3223 individuals with cerebral palsy","volume":"95","author":"Cloodt","year":"2024","journal-title":"Acta Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/j.1469-8749.1997.tb07414.x","article-title":"Development and reliability of a system to classify gross motor function in children with cerebral palsy","volume":"39","author":"Palisano","year":"1997","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_25","unstructured":"British Orthopaedic Association (1966). Joint Motion; Method of Measuring and Recording, British Orthopaedic Association."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/0167-9457(91)90046-Z","article-title":"A gait analysis data collection and reduction technique","volume":"10","author":"Davis","year":"1991","journal-title":"Hum. Mov. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.gaitpost.2023.05.028","article-title":"Evaluation of lower limb and pelvic marker placement precision among different evaluators and its impact on gait kinematics computed with the Conventional Gait Model","volume":"104","author":"Fonseca","year":"2023","journal-title":"Gait Posture"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.gaitpost.2007.11.009","article-title":"Quantitative comparison of five current protocols in gait analysis","volume":"28","author":"Ferrari","year":"2008","journal-title":"Gait Posture"},{"key":"ref_29","unstructured":"Hinkle, D.E., Wiersma, W., and Jurs, S.G. (2003). Applied Statistics for the Behavioral Sciences, Houghton Mifflin."},{"key":"ref_30","unstructured":"Portney, L.G., and Watkins, M.P. (2009). Foundations of Clinical Research: Applications to Practice, Pearson\/Prentice Hall."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Bartonek, \u00c5., and Lidbeck, C. (2023). Knee Flexion While Walking Exceeds Knee Flexion Contracture in Children with Spastic Cerebral Palsy. Children, 10.","DOI":"10.3390\/children10121867"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.gaitpost.2019.01.038","article-title":"Systematic review on gait classifications in children with cerebral palsy: An update","volume":"69","author":"Papageorgiou","year":"2019","journal-title":"Gait Posture"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Miller, F., Bachrach, S., Lennon, N., and O\u2019Neil, M.E. (2020). Knee Flexion Deformity in Cerebral Palsy. Cerebral Palsy, Springer International Publishing.","DOI":"10.1007\/978-3-319-50592-3"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.ridd.2018.06.013","article-title":"The natural history of crouch gait in bilateral cerebral palsy: A systematic review","volume":"80","author":"Horgan","year":"2018","journal-title":"Res. Dev. Disabil."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1097\/BPB.0000000000001174","article-title":"The impact of hamstring lengthening on stance knee flexion at skeletal maturity in ambulatory cerebral palsy","volume":"34","author":"Kanashvili","year":"2025","journal-title":"J. Pediatr. Orthop. Part B"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Pantzar-Castilla, E., Chen, B.P.-J., Miller, F., and Riad, J. (2021). The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04362-x"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.gaitpost.2008.05.001","article-title":"The gait deviation index: A new comprehensive index of gait pathology","volume":"28","author":"Schwartz","year":"2008","journal-title":"Gait Posture"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Graham, H.K., Thomason, P., Willoughby, K., Hastings-Ison, T., Stralen, R.V., Dala-Ali, B., Wong, P., and Rutz, E. (2021). Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study. Children, 8.","DOI":"10.3390\/children8030252"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1177\/18632521251330448","article-title":"Knee surveillance for ambulant children with cerebral palsy","volume":"19","author":"Thomason","year":"2025","journal-title":"J. Child. Orthop."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/01241398-199705000-00022","article-title":"The evolution of gait in childhood and adolescent cerebral palsy","volume":"17","author":"Johnson","year":"1997","journal-title":"J. Pediatr. Orthop."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Peeters, N., Papageorgiou, E., Hanssen, B., De Beukelaer, N., Staut, L., Degelaen, M., Van den Broeck, C., Calders, P., Feys, H., and Van Campenhout, A. (2022). The Short-Term Impact of Botulinum Neurotoxin-A on Muscle Morphology and Gait in Children with Spastic Cerebral Palsy. Toxins, 14.","DOI":"10.3390\/toxins14100676"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ridd.2017.07.002","article-title":"Longitudinal assessment of gait quality in children with bilateral cerebral palsy following repeated lower limb intramuscular Botulinum toxin-A injections","volume":"68","author":"Read","year":"2017","journal-title":"Res. Dev. Disabil."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8567\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:37:46Z","timestamp":1765211866000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8567"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":42,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238567"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238567","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,3]]}}}