Effectiveness of anterior guided growth in correction of knee flexion deformity in children with cerebral palsy: a prospective study

Background: Knee flexion deformity is a common and functionally disabling problem in children with cerebral palsy, leading to impaired gait, increased energy expenditure and progressive loss of mobility. Conventional surgical procedures provide correction but are associated with higher morbidity and risk of recurrence. Anterior guided growth (AGG) has emerged as a minimally invasive alternative that utilizes residual growth potential for gradual deformity correction. To evaluate the effectiveness of anterior guided growth in correcting fixed knee flexion deformity in children with cerebral palsy. Methods: This prospective study included skeletally immature children with cerebral palsy presenting with fixed knee flexion contracture who underwent anterior distal femoral hemiepiphysiodesis. Clinical assessment included measurement of fixed knee flexion contracture (FKFC) and popliteal angle using a goniometer. Radiological evaluation assessed sagittal plane alignment. Measurements were recorded preoperatively and compared with postoperative values at a minimum follow-up of 12 months. Statistical analysis was performed using repeated measures ANOVA and Friedman test. Results: There was a statistically significant reduction in fixed knee flexion contracture both clinically and radiologically over the follow-up period. The popliteal angle also showed significant improvement, indicating reduction in hamstring tightness. The correction was gradual and sustained, with an average correction rate consistent with growth modulation principles. Complications were minimal and no major implant-related failures were observed. Conclusions: Anterior guided growth is an effective, safe and minimally invasive technique for the management of moderate knee flexion deformity in children with cerebral palsy. It allows gradual correction with low morbidity and represents a valuable growth-preserving surgical option in appropriately selected patients.