Three-dimensional Gait Analysis Spanning 13 Years in a Patient with Unilateral Premature Physeal Arrest: A Case Report

Background: There are numerous etiologies relating to physeal arrest. The clinical manifestations of physeal arrest may include limb length discrepancy (LLD) and bone malalignment, especially in younger children with more growth ahead of them. Case: We performed threedimensional gait analysis (3DGA) four times over a 13-year period in a boy aged from 9 to 22 years who was suffering from LLD and genu valgum. At the final follow-up, the patient's LLD and coronal malalignment had been ameliorated on radiographic findings after multiple corrective surgeries, including the use of external fixation. In 3DGA, the patient's Gait Profile Score (GPS) at age 12.5 years was poorest at 12.4 degrees, improving to 8.4 degrees at age 22.3, a change of 2.5 times the minimal clinically important difference. Assessment of kinetics showed a mean knee coronal moment during the stance phase of 0.17 (varus) and 0.20 (valgus) Nm/kg at the ages of 18.6 and 22.3 years, respectively. Importantly, this revealed significant improvement from the perspective of knee coronal moment ( P <0.001). Discussion: This is the first report of long-term follow-up 3DGA using GPS in a patient undergoing multiple corrective surgeries for LLD and genu valgum. Although both LLD and genu valgum improved, gait function did not normalize. This shows that focusing on radiographic findings alone may not lead to improved patient outcomes and indicates the value of gait function assessment.