Orthopaedic care of adults with
cerebral palsy (CP) has not been well documented in orthopaedic literature. This paper focuses on some of the common problems which present themselves when adults with CP seek orthopaedic intervention. In particular, we review the most common orthopaedic issues which present to the Penn Neuro-Orthopaedics Program.
METHOD: A formal review of consecutive surgeries performed by the senior author on adults with CP was previously conducted. This paper focuses on the health delivery care for the adult with orthopaedic problems related to
cerebral palsy. Ninety-two percent of these patients required lower extremity surgery. Forty percent had procedures performed on the upper extremities.
RESULTS: The majority of problems seen in the Penn Neuro-Orthopaedics Program are associated with the residuals of childhood issues, particularly
deformities associated with
contractures. Patients are also referred for treatment of acquired musculoskeletal problems such as
degenerative arthritis of the hip or knee. A combination of problems contribute most frequently to
foot deformities and
pain with weight-bearing, shoewear or both, most often due to
equinovarus. The surgical correction of this is most often facilitated through a split anterior tibial
tendon transfer. Posterior tibial transfers are rarely indicated. Residual
equinus deformities contribute to a
pes planus deformity. The split anterior tibial
tendon transfer is usually combined with gastrocnemius-soleus recession and plantar release. Transfer of the flexor digitorum longus to the os calcis is done to augment the plantar flexor power. Rigid
pes planus deformity is treated with a triple
arthrodesis. Resolution of
deformity allows for a good base for standing, improved ability to tolerate shoewear, and/or
braces. Other recurrent or unresolved issues involve hip and knee
contractures. Issues of lever arm dysfunction create problems with mechanical inefficiency. Upper extremity intervention is principally to correct
contractures. Internal rotation and adductor tightness at the shoulder makes for difficult underarm hygiene and predispose a patient to a
spiral fracture of the humerus. A tight flexor, pronation pattern is frequently noted through the elbow and forearm with further flexion
contractures through the wrist and fingers. Lengthenings are more frequently performed than
tendon transfers in the upper extremity.
Arthrodesis of the wrist or on rare occasions of the metacarpal-phalangeal joints supplement the lengthenings when needed.
CONCLUSIONS: The Penn Neuro-Orthopaedics Program has successfully treated adults with both residual and acquired musculoskeletal
deformities. These
deformities become more critical when combined with degenerative changes, a relative increase in body mass,
fatigue, and weakness associated with the aging process.