Distal rectus femoris surgery in children with cerebral palsy: Results of a Delphi consensus project

Abstract

Purpose The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method. Methods The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached. Results Consensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade. Conclusion This study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP. Level of evidence V

Assessment of foot alignment and function for ambulatory children with cerebral palsy: Results of a modified Delphi technique consensus study

“…This panel has worked together on several other consensus projects identifying the indications for common surgical procedures used in single event multilevel surgery (SEMLS). [5][6][7] Panel members had a mean of over 20 years of experience (range: 10-41 years) in the orthopedic care of children with CP and a mean of 19.8 years (range: 7-31 years) of experience using 3DGA for clinical decision-making in children with CP. No members of the panel withdrew during the course of the consensus-seeking process.…”

“…The thresholds for these levels of consensus were based on the historical standards recommended in the literature and were used in previous consensus-seeking projects by the expert panel participating in this study. [5][6][7] Opportunity for comments was provided for all statements. Panel members were blinded to the responses of each other.…”

“…Previous work by this group has focused on the indications for hamstring lengthening, rectus femoris transfer, femoral derotation osteotomy, and gastrocsoleus lengthening. [5][6][7] Recently, the group directed its attention to the management of foot deformities in children with CP who are able to walk. The purpose of this study was to use expert's opinion, solicited through a modified e-Delphi technique, to establish consensus for the assessment of static foot alignment and dynamic foot function in children with CP.…”

“…Previous work by this group has focused on the indications for hamstring lengthening, rectus femoris transfer, femoral derotation osteotomy, and gastrocsoleus lengthening. 5 – 7 …”

What's New in Orthopaedic Management in Neuromuscular Disorders

“…Delphi techniques to improve decision-making and future research questions around gait-changing lower extremity surgery in children with cerebral palsy. [36][37][38] This year, in the literature, the debate and uncertainty continued. When and how to address stiff knee gait through rectus femoris surgery was the topic of the latest Delphi analysis.…”