Does patella lowering as part of multilevel surgery improve knee kinematics in children with cerebral palsy and crouch gait? A meta-analysis of comparative studies.

There was also a statistically significant increase in APT for the PLS group (MD = 3.05; 95% CI = [1.15, 4.96]; p = 0.002; I 2 = 0%; Figure 3(e) ) and an overall trend toward improvement in GDI ( Figure 3(f) ) and toward a reduction in pKFSw ( Figure 3(c) ), but these results did not reach statistical significance.

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However, improvements in gait deviation index and decrease in peak knee flexion in swing did not reach statistical significance.

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In summary, the analysis of particular subgroups according to different criteria led to the conclusion that (1) studies using the PTS technique reported significant improvements in all 3DGA parameters compared with no-PLS, while studies using the PTA technique showed a trend toward improvement that was not statistically significant; (2) as in the overall analysis, high-quality studies showed more improvement in stance-phase gait parameters, but not in KFC; and (3) studies with longer follow-up revealed no significantly superior improvement in KFIC, KFC, and GDI, no significant increase in APT, but a significant improvement in mKFSt and reduction in pKFSw for in the PLS group.

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