Ho, ho, ho! Gather ’round, my dear friends, as I tell you a tale of a surgical procedure known as Anterior Distal Femoral Hemiepiphysiodesis (ADFH). This procedure, much like Santa’s elves working tirelessly to make toys, is used to correct flexed knee gait and fixed knee flexion deformities in children with cerebral palsy who are still growing, much like the evergreen trees of the North Pole.

Now, some of you may have heard whispers that surgeries like these can lead to an increased anterior pelvic tilt, much like the tilt of my sleigh when it’s loaded with gifts. However, this particular tilt hasn’t been studied after ADFH. So, a group of diligent elves, I mean, researchers, set out to investigate this. They hypothesized that the anterior pelvic tilt would increase after ADFH, especially when combined with hamstring lengthening (HSL), and it would correlate with the change in minimum knee flexion in stance and dynamic hamstring lengths.

They gathered a group of 34 participants, all as eager as reindeer on Christmas Eve. They found that, indeed, the anterior pelvic tilt increased significantly after ADFH by 4.4 degrees (P = 0.02). However, this tilt only increased significantly in the group that had concurrent HSL (11.1 degrees, P < 0.001).

In the end, they concluded that ADFH without concurrent HSL for flexion knee deformities does not result in increased anterior pelvic tilt. So, surgeons should consider ADFH in patients with cerebral palsy and flexed knee gait, who preoperatively have long dynamically modeled hamstrings, are skeletally immature, and when maintenance of pelvic tilt is desired.

Just like how I consider the best route to deliver presents, surgeons should consider all factors before deciding on a treatment. And remember, my dear friends, this is a Level III-retrospective comparative study, much like comparing who's been naughty or nice! Ho, ho, ho!