Surgical treatment of knee flexion contracture in patients with cerebral palsy: a review

Knee flexion contracture is the most common lower limb deformity among patients with cerebral palsy, with a prevalence of 47%–53%. Its prolonged persistence leads to marked functional impairments, such as increased energy expenditure during walking and decreased motor activity in children, and the emergence of secondary orthopedic complications, which significantly affects patients’ quality of life. This review analyzed published scientific data on current surgical methods for the correction of knee flexion contracture in patients with cerebral palsy, evaluating their clinical effectiveness, determining frequency of complications, and identifying factors influencing the choice of optimal treatment strategy. The studies were determined using PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary. The search was conducted without language restrictions, covering the period from 1952 to 2024. Seventy-four sources were reviewed, including original articles and systematic reviews on surgical treatment of knee flexion contracture in patients with cerebral palsy. The primary surgical correction methods for knee flexion contracture in children with cerebral palsy are hamstring lengthening and distal femoral extension supracondylar osteotomy. Hamstring lengthening is considered the main surgical procedure and most appropriate option for patients of all age groups. Notably, femoral osteotomy has shown high clinical effectiveness in older patients, particularly in those with marked distal femoral deformities. Both methods yield favorable outcomes, but may be associated with certain complications. Furthermore, this review discusses alternative techniques, including tendon transfers and temporary hemiepiphysiodesis, and combined approaches. The conducted scientific data review confirmed the effectiveness of surgical treatment of knee flexion contracture in patients with cerebral palsy. However, in selecting a particular surgical procedure, individual anatomical and clinical features, the degree of contracture, and age-related patient characteristics should be considered.