Long-Term Results After Distal Rectus Femoris Transfer as a Part of Multilevel Surgery for the Correction of Stiff-Knee Gait in Spastic Diplegic Cerebral Palsy

Dreher, Thomas; Wolf, Sebastian I.; Maier, Michael W.; Hagmann, Sébastien; Végvári, Dóra; Gantz, Simone; Heitzmann, Daniel; Wenz, W; Braatz, Frank

doi:10.2106/jbjs.k.01300

Cited by 48 publications

(48 citation statements)

References 28 publications

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“…There are numerous reports regarding the treatment of stiff knee gait using DRFT or proximal rectus femoris release [1,4,6,8,11,18,20,21,23,27,30,32,33,35,38]. Good initial results were reported [1,4,8,11,20,21,23,27,32,33,38].…”

Section: Discussionmentioning

confidence: 99%

“…Good initial results were reported [1,4,8,11,20,21,23,27,32,33,38]. However, some authors have reported discrepant outcomes after DRFT [6,18,30,35], and a poor or no response rate of approximately 20% was found in a recent long-term investigation [6]. These inconsistent outcomes may be explained by a persistent extensor moment of the rectus femoris after transfer [2,3,28].…”

Section: Discussionmentioning

confidence: 99%

“…The patients in the DRFT group received DRFT only, whereas the other patient group received DRFT and a proximal rectus femoris release. Standard surgical techniques were used for both procedures [6,16,38].…”

Section: Methodsmentioning

confidence: 99%

“…To improve knee flexion and swing phase clearance, standard surgical treatment involves distal femoris tendon transfer, which is commonly performed as part of single-event multilevel surgery. The beneficial effects after distal rectus femoris transfer (DRFT) for knee kinematics are well documented; however, inconsistent results have been reported [8,11,18,20,21,27,30,33], and in some patients no effect was observed after DRFT [6]. Some authors suggested that even after transfer, a knee extensor moment remains in the rectus femoris [2,3,28].…”

Section: Introductionmentioning

confidence: 99%

“…Some authors reported recurrence of stiff knee gait in a relevant number of patients [6] and scarring at the transfer site is believed to be one possible reason for recurrence [7]. Fox et al [7] reported a potential indirect effect of the hip flexion on the knee induced by the rectus femoris.…”

Section: Introductionmentioning

confidence: 99%

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Does Proximal Rectus Femoris Release Influence Kinematics In Patients With Cerebral Palsy and Stiff Knee Gait?

Végvári

Wolf

Heitzmann

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Stiff gait resulting from rectus femoris dysfunction in cerebral palsy commonly is treated by distal rectus femoris transfer (DRFT), but varying outcomes have been reported. Proximal rectus femoris release was found to be less effective compared with DRFT. No study to our knowledge has investigated the effects of the combination of both procedures on gait. Questions/purposes We sought to determine whether an additional proximal rectus release affects knee and pelvic kinematics when done in combination with DRFT; specifically, we sought to compare outcomes using the (1) range of knee flexion in swing phase, (2) knee flexion velocity and (3) peak knee flexion in swing phase, and (4) spatiotemporal parameters between patients treated with DRFT, with or without proximal rectus release. Furthermore the effects on (5) anterior pelvic tilt in both groups were compared. Methods Twenty patients with spastic bilateral cerebral palsy treated with DRFT and proximal rectus femoris release were matched with 20 patients in whom only DRFT was performed. Standardized three-dimensional gait analysis was done before surgery, at 1 year after surgery, and at a mean of 9 years after surgery. Basic statistics were done to compare the outcome of both groups. Results The peak knee flexion in swing was slightly increased in both groups 1 year after surgery, but was not different between groups. Although there was a slight but not significant decrease found the group with DRFT only, there was no significant difference at long-term followup between the groups. Timing of peak knee flexion, range of knee flexion, and knee flexion velocity improved significantly in both groups, and in both groups a slight deterioration was seen with time; there were no differences in these parameters between the groups at any point, however. There were no group differences in spatiotemporal parameters at any time. There were no significant differences in the long-term development of anterior pelvic tilt between the groups. Conclusions The results of our study indicate that the short-and long-term influences of adding proximal rectus femoris release on the kinematic effects of DRFT and on pelvic tilt in children with cerebral palsy are negligible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does Proximal Rectus Femoris Release Influence Kinematics In Patients With Cerebral Palsy and Stiff Knee Gait?

Végvári

Wolf

Heitzmann

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Single‐Event Multilevel Surgery to Correct Movement Disorders in Children with Cerebral Palsy

Wick¹,

Feng²,

Raney³

et al. 2018

AORN Journal

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Cerebral palsy (CP) is a common motor disability that may be congenital or acquired. Children with CP often have gait, balance, and posture abnormalities, some of which may be severe enough to interfere with safe ambulation or other activities of daily living. Nonsurgical and surgical interventions are part of the management plan for children with CP. Historically, surgeons addressed gait deviations individually and sequentially with single‐level surgeries. However, computerized motion analysis and advances in orthopedic internal fixation devices have improved the outcomes for patients undergoing single‐event multilevel surgery. This article provides perioperative RNs with a basic understanding of movement disorders that can be corrected with single‐event multilevel surgery, the role of computerized motion analysis in making treatment decisions for ambulatory pediatric orthopedic patients with CP, and various treatment options for the movement disorders of children with CP.

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Swing Phase Problems in Cerebral Palsy

Presedo¹

2018

Handbook of Human Motion

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Long-Term Results After Distal Rectus Femoris Transfer as a Part of Multilevel Surgery for the Correction of Stiff-Knee Gait in Spastic Diplegic Cerebral Palsy

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 48 publications

References 28 publications

Does Proximal Rectus Femoris Release Influence Kinematics In Patients With Cerebral Palsy and Stiff Knee Gait?

Does Proximal Rectus Femoris Release Influence Kinematics In Patients With Cerebral Palsy and Stiff Knee Gait?

Single‐Event Multilevel Surgery to Correct Movement Disorders in Children with Cerebral Palsy

Swing Phase Problems in Cerebral Palsy

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