Lower limb contracture definitions in children and adults with cerebral palsy: A systematic review

Aim

To examine the quantitative definitions and prevalence rates of fixed lower limb contractures in people with cerebral palsy (CP). Based on findings, to propose standardized values to define lower limb contractures to improve quality in future research.

Method

A systematic review was conducted according to PRISMA guidelines using 4 databases from inception to April 2024. Titles, abstracts, and full texts were independently screened. Data were extracted and quality assessed independently by 2 reviewers. Data were synthesized and presented descriptively.

Results

Forty-four studies were included. Ankle plantarflexion contracture definitions ranged from < 10° dorsiflexion to ≥ 20° plantarflexion, and prevalence rates ranged from 32 % to 90 %. Knee flexion contracture definitions ranged from > 0° to ≥ 30° flexion, and prevalence rates ranged from 19 % to 44 %. Hip flexion contracture definitions ranged from > 0° to ≥ 30° flexion, and prevalence rates ranged from 7 % to 68 %. Hip extension and abduction contractures were seldom defined.

Interpretation

There is considerable variability in reported contracture definitions and prevalence rates. Based on findings, we propose the following cut-offs for defining contractures; ankle plantarflexion contracture < 0° dorsiflexion, knee flexion contracture < 0° knee extension, hip flexion contracture < 0° hip extension, hip abduction contracture < 30° hip abduction, hip extension contracture ≤ 90° hip flexion range of motion.