Proximal Rectus Femoris Release Surgery Is Not Effective in Normalizing Hip and Pelvic Variables During Gait in Children With Cerebral Palsy

McMulkin, Mark L.; Baird, Glen O.; Barr, Kory M.; Caskey, Paul M.; Ferguson, Ron L.

doi:10.1097/00004694-200501000-00017

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…In agreement with other authors [6,25], we consider the restriction of abduction by more than 301 as a contracture of adductors and we suggest adductor muscle tenotomy as preventive hip surgery because adductor tenotomy reduces the trend toward lateral displacement of the hip joint [26]. Hip flexor contracture is believed to result in gait deviations including restricted stride length, excessive anterior pelvic tilt, increased lumbar lordosis and limited hip extension in stance [27]. Proximal rectus femoris release was initially proposed to reduce hip flexion contracture and lumbar lordosis while improving knee flexion in swing [28].…”

Section: Discussionsupporting

confidence: 89%

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Evolution of walking ability after soft tissue surgery in cerebral palsy patients: what can we expect?

Švehlík¹,

Slabý²,

Soumar

et al. 2008

Journal of Pediatric Orthopaedics B

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Eleven patients with spastic cerebral palsy were evaluated preoperatively, and 3 and 9 months postoperatively after soft tissue surgery. Evaluation included clinical examination, the Functional Mobility Scale questionnaire, and instrumented gait and center of mass trajectory analysis. A decrease in time-distance parameters after 3 months was followed by progress in all parameters at 9 months postoperatively. Push-off range of ankle motion decreased after surgery and was not restored to preoperative level until 9 months later. The center of mass vertical displacement improved significantly. The Functional Mobility Scale showed gait improvement. Despite the normalization of range of motion after surgery, there is an obvious period of functional gait deterioration in the early postoperative period and the push-off range of motion at the ankle did not recover to preoperative level until 9 months later.

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Section: Discussionsupporting

confidence: 89%

“…Our aim was to address anterior pelvic tilt, hyperlordosis and reduced hip extension by proximal rectus femoris release. Contrary to the results of some authors [27], we have good clinical experience with this procedure, which we have already published [32].…”

Section: Discussioncontrasting

confidence: 56%

Evolution of walking ability after soft tissue surgery in cerebral palsy patients: what can we expect?

Švehlík¹,

Slabý²,

Soumar

et al. 2008

Journal of Pediatric Orthopaedics B

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“…Since then, most published cases of muscle contracture seem to be related to injections in childhood, such as, fibrous quadriceps [3,4,8,9,13,[18][19][20][21][22][23][24][25][26], fibrous triceps [1,27,28], fibrous deltoid [2,12,14,[28][29][30][31][32][33][34], stiffness of the knee with dislocation of the patella due to fibrous quadriceps [7,14,22], fibrous gluteus maximus [5,8], and fibrous RFM [10,22,23,35].…”

Section: Discussionmentioning

confidence: 99%

Analysis of two different techniques in the treatment of knee stiffness in swing phase due to fibrous rectus femoris muscle in children

Hưng¹

2011

Journal of Pediatric Orthopaedics B

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The objective of this study was to analyze two surgical techniques in the treatment of fibrous rectus femoris muscle in children. Data from 152 patients (161 knees) from July 1991 to December 2004 were analyzed. Clinical signs were knee stiffness in swing phase, positive Ely and Ober tests, and abnormal flexion angles of the knee and hip. Patients were operated according to one of two variants: variant A, to release the proximal tendon and variant B, to release the middle shaft of the rectus femoris muscle. There were 96 women (63.2%) and 56 men (36.8%) in this study. Bilateral involvement was found in nine patients; only the left knee was affected in 34 patients (22.4%) and only the right knee in 109 patients (71.7%). All 152 patients (161 knees) developed fibrous rectus femoris muscle (RFM) after repeated intramuscular injection of antibiotic(s) into the RFM. A total of 145 knees (136 patients) were classified as severe and 16 knees (16 patients) were classified as moderate. Overall, we attained excellent results in 109 (67.7%), good results in 26 (16.1%), fair results in 14 (8.7%), and poor results in 12 knees (7.5%). There have been no complications so far. Generally, surgical treatment of knee stiffness in swing phase due to fibrous RFM according to variant B led to postoperative poor results in only 1.2% of patients, whereas variant A gave postoperative poor results in 14.5% of patients. The surgical procedure is simple and safe, and knee and hip functions, tendency for crouch gait, and anterior pelvic tilt were remarkably improved.

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“…Gait analysis [17,18,30,34] is a typical tool for studying the ambulation limitations placed on a patient with CP. In general, gait analysis does an excellent job at defining the functional deficits associated with CP, but it has limitations.…”

Section: Introductionmentioning

confidence: 99%

“…In general, gait analysis does an excellent job at defining the functional deficits associated with CP, but it has limitations. It is often a two-dimensional data acquisition and analysis [12,17], is prone to skin motion errors [16], and is less accurate in measuring motion in the frontal and coronal planes [15]. Further, gait in patients with limited mobility may be difficult to assess because of short step lengths, slow speed, endurance, and other factors.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional In Vivo Quantification of Knee Kinematics in Cerebral Palsy

Sheehan

Seisler

Alter

2008

Clinical Orthopaedics &Amp; Related Research

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Cerebral palsy is the most common disabling condition in childhood, involving a diverse group of movement and posture disorders of varying etiologies. Yet, much is unknown about how cerebral palsy affects individual joints because currently applied techniques cannot quantify the three-dimensional kinematic parameters at the joint level. We quantified the effects of cerebral palsy at the knee using fast phase contrast MRI, with the ultimate intent of improving the assessment of joint impairments associated with cerebral palsy, improving clinical outcomes, and reducing the impact of cerebral palsy on function. We addressed three questions: (1) Can patients with cerebral palsy perform the required repetitive extension task? (2) Which of the 12 degrees of freedom defining complete knee kinematics are abnormal in individual patients with cerebral palsy and is the patellar tendon moment arm abnormal in these patients? (3) Are the individual kinematic differences consistent with clinical observations? All patients were able to perform the required task. We found kinematic differences for each patient with cerebral palsy consistent with clinical findings, in comparison to an able-bodied population. Fast phase contrast MRI may allow differentiation of patellofemoral and tibiofemoral function in various functional subtypes of cerebral palsy, providing insights into its management.

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Proximal Rectus Femoris Release Surgery Is Not Effective in Normalizing Hip and Pelvic Variables During Gait in Children With Cerebral Palsy

Cited by 7 publications

References 10 publications

Evolution of walking ability after soft tissue surgery in cerebral palsy patients: what can we expect?

Evolution of walking ability after soft tissue surgery in cerebral palsy patients: what can we expect?

Analysis of two different techniques in the treatment of knee stiffness in swing phase due to fibrous rectus femoris muscle in children

Three-dimensional In Vivo Quantification of Knee Kinematics in Cerebral Palsy

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