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Background <p>Cerebral palsy (CP) is one of the most common causes of physical disability in childhood. While the Gross Motor Function Classification System (GMFCS) describes motor abilities, a&#xa0;unified classification for musculoskeletal pathologies was lacking. The newly proposed four-stage system—based on the Mercer Rang model—describes the progression of lower limb pathology and supports diagnosis, treatment planning, and research.</p> Stage&#xa0;1 <p>Hypertonia: From birth to about 6 years, spasticity and delayed motor development predominate; contractures are rare. Early intervention and spasticity management (e.g., botulinum toxin) are the focus.</p> Stage&#xa0;2 <p>Contractures: Between the ages of 4 and 12 years, discrepancies between muscle-tendon length and bone growth cause a reduced range of motion. Surgical muscle or tendon lengthening may be indicated.</p> Stage&#xa0;3 <p>Bony deformities: Bony deformities such as increased femoral anteversion or pes valgus occur simultaneously with soft tissue contractures; rotational osteotomies and combined multilevel surgeries (SEMLS) are often required.</p> Stage&#xa0;4 <p>Decompensated pathology: After puberty, irreversible deformities and joint degeneration develop. Surgery usually aims at pain reduction or stabilization (e.g., arthrodesis).</p> Conclusion <p>This classification raises awareness of disease progression, helps select stage-appropriate treatments, and may prevent over- or undertreatment. Early recognition and intervention are crucial to avoid decompensation and improve long-term musculoskeletal and functional outcomes.</p>

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Muskuloskelettale Pathologien bei Kindern mit infantiler Zerebralparese: ein neues Klassifikationssystem

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月11日

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  • L. M. Kessling,
  • R. A. van Stralen,
  • J. J. Tolk,
  • H. K. Graham,
  • E. Rutz

摘要

Background

Cerebral palsy (CP) is one of the most common causes of physical disability in childhood. While the Gross Motor Function Classification System (GMFCS) describes motor abilities, a unified classification for musculoskeletal pathologies was lacking. The newly proposed four-stage system—based on the Mercer Rang model—describes the progression of lower limb pathology and supports diagnosis, treatment planning, and research.

Stage 1

Hypertonia: From birth to about 6 years, spasticity and delayed motor development predominate; contractures are rare. Early intervention and spasticity management (e.g., botulinum toxin) are the focus.

Stage 2

Contractures: Between the ages of 4 and 12 years, discrepancies between muscle-tendon length and bone growth cause a reduced range of motion. Surgical muscle or tendon lengthening may be indicated.

Stage 3

Bony deformities: Bony deformities such as increased femoral anteversion or pes valgus occur simultaneously with soft tissue contractures; rotational osteotomies and combined multilevel surgeries (SEMLS) are often required.

Stage 4

Decompensated pathology: After puberty, irreversible deformities and joint degeneration develop. Surgery usually aims at pain reduction or stabilization (e.g., arthrodesis).

Conclusion

This classification raises awareness of disease progression, helps select stage-appropriate treatments, and may prevent over- or undertreatment. Early recognition and intervention are crucial to avoid decompensation and improve long-term musculoskeletal and functional outcomes.