Introduction: In children with cerebral palsy the abnormal activity of the rectus femoris (RF) during the swing phase results in "stiff-knee gait". Transferring the RF to a knee flexor tendon improves this stiffness. The effect may be limited by adhesions from scar tissue or from angular deviations along the surgically created muscle tendon route.
Hypothesis: The goal of this study was to assess the effect on gait of a single event multilevel surgery protocol, and provide a detailed description of the transfer technique.
Patients and methods: Forty-eight RF transfers were studied in 26 children and adolescents 12 ± 3 years old after a follow up of 25 ± 10 months. Quantified gait analysis was performed pre- and postoperatively to calculate spatiotemporal variables, 3D kinematics, the Gait Deviation Index (GDI) and a knee stiffness score (Goldberg index). A standardized surgical procedure was followed: RF release, gracilis tendon preparation as well as the transfer and suture techniques are described.
Results: Step length improved. Gait velocity and cadence were not modified. Gait quality improved (+13 ± 11 GDI) with an inverse relationship between the preoperative GDI and its improvement. Improvement of the preoperative Goldberg index in 74% of the cases was due to modifications of knee ROM from toe-off to peak flexion (+7°), total knee ROM (+16°) and timing of peak knee flexion in percentage of swing (from 51 to 40% of swing).
Discussion: The surgical protocol presented here is discussed in relation to the results.
Level of evidence: IV, retrospective study.
Copyright © 2013. Published by Elsevier Masson SAS.