Does the GMFCS level influence the improvement in knee range of motion after rectus femoris transfer in cerebral palsy?

Abstract

The aim of this study was to evaluate the influence of the Gross Motor Function Classification System (GMFCS) on the outcomes of rectus femoris transfer (RFT) for patients with cerebral palsy and stiff knee gait. We performed a retrospective review of patients seen at our gait laboratory from 1996 to 2013. Inclusion criteria were (i) spastic diplegic cerebral palsy, (ii) GMFCS levels I-III, (iii) reduced peak knee flexion in swing (PKFSw<55°), and (iv) patients who underwent orthopedic surgery with preoperative and postoperative gait analysis. Patients were divided into two groups according to whether they received a concurrent RFT or not at the time of surgery: non-RFT group (185 knees) and RFT group (123 knees). The primary outcome was the overall knee range of motion (KROM) derived from gait kinematics. The secondary outcomes were the PKFSw and the time of peak knee flexion in swing (tPKFSw). We observed a statistically significant improvement in KROM only for patients in the RFT group (P<0.001). However, PKFSw and tPKFSw improved in both groups after surgery (P<0.001 for all analyses). In the RFT group, the improvement in KROM was observed only for patients classified as GMFCS levels I and II. In the non-RFT group, no improvement in KROM was observed in any GMFCS level. In this study, patients at GMFCS levels I and II were more likely to benefit from the RFT procedure.

Rectus femoris transfer in children with cerebral palsy: comparing a propensity score‐matched observational study to a randomized controlled trial

“…Other studies had control groups that were poorly matched 16 . Studies with sizeable, reasonably well‐matched control groups showed effect sizes like those in the original report 17,18 …”

“…16 Studies with sizeable, reasonably well-matched control groups showed effect sizes like those in the original report. 17,18 Why have there been so few RCTs examining the outcomes of RFT? The primary answer is that conducting an RCT for surgery in ambulatory children diagnosed with CP is exceptionally difficult due to practical, ethical, and combinatory challenges.…”

Multilevel Surgery for Children With Cerebral Palsy: A Meta-analysis

“…A description of each study is presented in Table 1. MINORS score ranged from 4 20 to 21 9 (Supplemental Table 3).…”

“…In studies that included a comparison group, results between male and female patients, 92 between participants with diplegia and hemiplegia, 73 between participants with more or less than a 5-degree increase in anterior pelvic tilt, 25 or between patients who received different surgical procedures as part of MLS were compared. 20,30,34,39,54,55,60,86,89 Seventeen studies were prospective cohort studies, of which a singlesubject AB design was used in 1, 22 and 2 surgical procedures as part of MLS were compared in 2. 36,88 Four studies were RCTs in which 2 surgical procedures as part of MLS 32,53 or 2 types of rehabilitation after MLS were compared.…”

“…87 Results from a further 8 studies are reported descriptively because insufficient information was provided to include them in the meta-analysis. 29,47,48,51,56,57,81,85 Data on 12 studies are not reported because authors of 8 studies assessed individual gait variables or GMFCS level, 20,31,43,44,52,54,59,62 and authors of 4 studies did not report results from statistical analyses to allow interpretation of findings. 22,40,49,78 Gross Motor Function…”