The effect of lengthening of the femur on the extensors of the knee. An electromyographic study.

Kaljumäe, Üllar; Märtson, Aare; Haviko, Tiit; Hänninen, O

doi:10.2106/00004623-199502000-00011

Cited by 32 publications

(17 citation statements)

References 14 publications

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“…None of these patients complained for muscle weakness and functional disability. These findings were consistent with the results of Kaljumae et al who hypothesized that lengthening of the femur could create an ischemic environment and result in muscle atrophy although they did not detect any functional impairment of the extremities [14]. Yoshipovitch and Palti had already proved pathological changes of blood pressure in the extremities during lengthening [15].…”

Section: Discussionsupporting

confidence: 89%

Residual malformations and leg length discrepancy after treatment of fibular hemimelia

Alaseirlis¹,

Korompilias

Beris

et al. 2011

J Orthop Surg Res

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BackgroundFibular hemimelia has been reported as the most common congenital longitudinal deficiency of the long bones. Previous studies have focused on the best treatment options for this congenital condition. There is very little to our knowledge in the literature focused on residual persisting malformations and leg length discrepancy after treatment.MethodsSeven patients presenting fibular hemimelia in eight fibulae received treatment between years 1988 and 2001. Pre-treatment average leg length discrepancy was 5.3 cm. All patients presented associated congenital deformities of the ipsilateral leg. Six patients received surgical treatment. Average post-treatment follow up was 9.7 years. Residual malformations and leg length discrepancy were recorded for all patients. It is a retrospective case series study at one institution by two of the presenting authors as senior surgeons.ResultsAverage leg length gained after successful bone lengthening in six patients was 5.06 cm. Although there was a significant functional improvement, a number of residual malformations and leg length inequality was recorded. Residual average leg length discrepancy of 3.1 cm was observed in five patients who completed surgical treatment. Five patients presented a limp. Residual anterior-medial bowing of the tibia was observed in four patients. Calf atrophy was present in all seven patients. Valgus deformity of the ankle was remained in two patients.ConclusionsTreatment of fibular hemimelia, even in cases graded as successful, showed to be accompanied by a number of persisting residual deformities and recurrent leg length inequality. Although the number of patients is limited, the high rate of this phenomenon is indicative of the significance of the report. The family and the patients themselves should have the right expectations and will be more co-operative when well informed about this instance. A report of common post-treatment residual deformities should be valuable in best possible treatment planning of fibular hemimelia.

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Section: Discussionsupporting

confidence: 89%

Residual malformations and leg length discrepancy after treatment of fibular hemimelia

Alaseirlis¹,

Korompilias

Beris

et al. 2011

J Orthop Surg Res

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“…The causes of these contractures are not fully understood, but thought to be due in part to inadequate adaptation of muscle, connective tissue, blood vessel, and nerve. 9,18,[20][21][22][23] Another proposed theory is that lengthening-induced muscle contractures occur due to a strength imbalance between agonist and antagonist muscles. 24,25 Relatively recent recognition of the problem has led to an increasing shift in focus from characterization ofbone adaptation to that of the attendant soft tissue problems.…”

Section: Introductionmentioning

confidence: 99%

Effects of botulinum toxin A on functional outcome during distraction osteogenesis

Olabisi

Best

Vanderby

et al. 2007

Journal Orthopaedic Research

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Distraction osteogenesis is useful for correcting limb length inequality, deformities, or short stature. Despite success with bone formation, soft tissue maladaptations including muscle and joint contracture may lead to undesirable results. Botulinum toxin A has been useful in treating spasticity in cerebral palsy, and has been used clinically in select cases to allay contracture in distraction osteogenesis. This study examines the toxin's efficacy in preventing distraction-induced loss of muscle strength and range of motion. The left tibias of 15 New Zealand White rabbits were distracted 1.5 mm/day until approximately a 20% gain was achieved. Each treatment group was divided into animals injected with saline or botulinum toxin in either the gastrocnemius or tibialis anterior muscles. A control group of two additional animals underwent no surgical procedure. Strength and range of motion were assessed prior to, and following, the experiment. At the study's end, animals were euthanized and muscles were harvested, when lengths and weights were recorded. All muscles injected with botulinum toxin showed decreased wet weight and persistent weakness upon completion of the study. Range of motion decreased in all distracted animals. When the gastrocnemius was injected, its strength was reduced but the tibialis anterior strength was preserved, and the limb achieved 22% greater dorsiflexion than saline controls (p ¼ 0.016). When the tibialis anterior received the toxin, plantarflexion was increased by 23% (p ¼ 0.049). Botulinum toxin injection prior to limb distraction increases the ''post-lengthened'' excursion of the injected muscle and this increased length may have a protective effect on its antagonist. In toxin-injected gastrocnemius muscles, the level of equinus contracture is reduced due to length gains in the Achilles tendon while the anterior tibialis maintains its ability to generate torque. Injection of botulinum toxin in the gastrocnemius may minimize equinus contracture and protect the anterior tibialis from damage during human tibial lengthening. Longer follow-up studies are needed to ensure that toxininduced muscle weakness resolves with time. ß

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“…Causes of this weakness are thought to be disuse and neurogenic factors (Kaljumäe et al. 1995, Oey et al. 1999).…”

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confidence: 99%

Muscle strength and knee range of motion after femoral lengthening

et al. 2016

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Background and purposeFemoral lengthening may result in decrease in knee range of motion (ROM) and quadriceps and hamstring muscle weakness. We evaluated preoperative and postoperative knee ROM, hamstring muscle strength, and quadriceps muscle strength in a diverse group of patients undergoing femoral lengthening. We hypothesized that lengthening would not result in a significant change in knee ROM or muscle strength.Patients and methodsThis prospective study of 48 patients (mean age 27 (9–60) years) compared ROM and muscle strength before and after femoral lengthening. Patient age, amount of lengthening, percent lengthening, level of osteotomy, fixation time, and method of lengthening were also evaluated regarding knee ROM and strength. The average length of follow-up was 2.9 (2.0–4.7) years.ResultsMean amount of lengthening was 5.2 (2.4–11.0) cm. The difference between preoperative and final knee flexion ROM was 2° for the overall group. Congenital shortening cases lost an average of 5% or 6° of terminal knee flexion, developmental cases lost an average of 3% or 4°, and posttraumatic cases regained all motion. The difference in quadriceps strength at 45° preoperatively and after lengthening was not statistically or clinically significant (2.7 Nm; p = 0.06). Age, amount of lengthening, percent lengthening, osteotomy level, fixation time, and lengthening method had no statistically significant influence on knee ROM or quadriceps strength at final follow-up.InterpretationMost variables had no effect on ROM or strength, and higher age did not appear to be a limiting factor for femoral lengthening. Patients with congenital causes were most affected in terms of knee flexion.

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The effect of lengthening of the femur on the extensors of the knee. An electromyographic study.

Cited by 32 publications

References 14 publications

Residual malformations and leg length discrepancy after treatment of fibular hemimelia

Residual malformations and leg length discrepancy after treatment of fibular hemimelia

Effects of botulinum toxin A on functional outcome during distraction osteogenesis

Muscle strength and knee range of motion after femoral lengthening

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