FLEXION CONTRACTURES OF THE KNEE JOINTS IN CHILDREN WITH CEREBRAL PALSY: PATHOGENESIS, CLINICAL MANIFESTATIONS, ANATOMICAL AND MORPHOLOGICAL CHANGES IN BONES, MUSCLES AND INTRA-ARTICULAR STRUCTURES

Abstract

The main causes of knee contractures are the dominance of the hamstring muscles, particularly the biceps femoris, as well as associated hip joint contractures, which are combined with torsional deformities of the lower limb bones. Femoral deformity involves anteversion of its proximal epimetaphysis, which arose during ontogenesis and due to the action of external rotators, as well as internal rotation resulting from spasticity of the hip adductor muscles. Pathological external torsion of the tibia is a consequence of a compensatory mechanism aimed at restoring the axis of the lower limb, overcoming spasticity of the biceps femoris muscle, and retraction of the anterior cruciate ligament. Objective. To investigate the pathogenesis of flexion contractures of the knee joints, as well as associated anatomical and structural changes in the bones and primary and secondary stabilizers in children with cerebral palsy. Methods. The analyzed data were obtained during the treatment of 40 patients with cerebral palsy, spastic diplegia, and tetraparesis. In all cases, hip joint contractures were noted, and in most patients, knee joint contractures and foot deformities were observed. Clinical and instrumental diagnostic methods were used. Results. The causes of flexion contractures of the knee joints were studied, theoretically substantiated, and investigated. A direct correlation was established between the degree of contracture and degenerative-dystrophic changes in the intra-articular tissues of the joint, as well as between the degree of torsional deformity of the lower limb bones. Conclusions. The pathogenesis of knee joint contractures is multifactorial in nature and depends on structural changes in the bones of the lower extremities and in the primary and secondary stabilizers of the knee joint, which influences the clinical course of the disease and the future choice of treatment strategy.